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Intravenous antimicrobial treatment regimens for epiglottitis

Intravenous antimicrobial treatment regimens for epiglottitis
Regimen Pediatric dose Adult dose
Two-drug regimens
Ceftriaxone OR

50 to 100 mg/kg per day once daily or in two divided doses

Maximum daily dose 2 g
2 g every 24 hours
Cefotaxime

150 to 200 mg/kg per day in four divided doses

Maximum daily dose 10 g
2 g every 4 to 8 hours
PLUS
Vancomycin* OR

40 to 60 mg/kg per day in three to four divided doses

Maximum daily dose 2 g

Loading dose: 20 to 35 mg/kg

Initial maintenance dose and interval determined by nomogram;Δ typically 15 to 20 mg/kg every 8 to 12 hours for most patients with normal renal function

Subsequent dose and interval adjustments based on AUC-guided (preferred) or trough-guided serum concentration monitoring
Clindamycin OR

30 to 40 mg/kg per day in three divided doses

Maximum daily dose 2.7 g
600 to 900 mg every 8 hours
Oxacillin§ OR

150 to 200 mg/kg per day in four divided doses

Maximum daily dose 12 g
1 to 2 g every 4 to 6 hours
Nafcillin§ OR

150 to 200 mg/kg per day in four divided doses

Maximum daily dose 12 g
2 g every 4 hours
Cefazolin§

75 to 100 mg/kg per day in three divided doses

Maximum daily dose 6 g
1 to 2 g every 6 hours
AUC: area under the concentration-time curve.
* Vancomycin is indicated in patients with moderate to severe sepsis, patients who may have concomitant meningitis, and patients from areas with an increased prevalence of clindamycin-resistant and/or methicillin-resistant Staphylococcal aureus isolates.
¶ The vancomycin loading dose is based on actual body weight, rounded to the nearest 250 mg increment and not exceeding 3000 mg. Within this range, we use a higher dose for critically ill patients.
Δ Refer to UpToDate topic on vancomycin dosing for sample nomogram.
Refer to UpToDate topic on vancomycin dosing for discussion of AUC-guided and trough-guided vancomycin dosing.
§ Oxacillin, nafcillin, and cefazolin should only be used as part of combination therapy in patients for whom methicillin-resistant S. aureus is not a consideration.
Graphic 60306 Version 6.0

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