Version July 2025
| Antimicrobial therapy | Dose* | Spectrum | Comments |
| Oral therapy | |||
Amoxicillin-clavulanate¶
| 40 mg/kg per day orally divided every 8 hours (maximum 1.5 g/day) | MSSA GAS Oral anaerobes | Anaerobic coverage indicated for associated periodontal disease or poor dental hygiene |
Amoxicillin-clavulanate¶
| 25 to 45 mg/kg per day orally divided every 12 hours (maximum 1.75 g/day) | MSSA GAS Oral anaerobes | Anaerobic coverage indicated for associated periodontal disease or poor dental hygiene |
| Cefadroxil | 30 mg/kg per day orally divided every 12 hours (maximum 2 g/day) | MSSA GAS | |
| Cephalexin | 25 to 100 mg/kg per day orally divided every 6 or 8 hours (maximum 4 g/day) | MSSA GAS | |
| Clindamycin◊ | 30 mg/kg per day orally divided every 6 or 8 hours (maximum 1.8 g/day) | MSSA◊ MRSA◊ GAS Oral anaerobes | Anaerobic coverage indicated for associated periodontal disease or poor dental hygiene Oral suspension may be unpalatable, affecting adherence |
| Trimethoprim-sulfamethoxazole§ (TMP-SMX, cotrimoxazole) | 10 mg/kg per day orally divided every 12 hours (maximum 320 mg/day) | MSSA MRSA Bartonella henselae | Not active against GAS, so should not be used for empiric therapy |
| Parenteral therapy | |||
| Ampicillin-sulbactam¶ | 100 to 200 mg/kg per day IV divided every 6 hours (maximum 8 g/day of ampicillin component) | MSSA GAS Oral anaerobes Gram-negative organisms | Anaerobic coverage indicated for associated periodontal disease or poor dental hygiene |
| Cefazolin | 50 to 100 mg/kg per day IV divided every 8 hours (maximum dose 6 g/day) | MSSA GAS | |
| Clindamycin◊ | 40 mg/kg per day IV divided every 6 or 8 hours (maximum 2.7 g/day) | MSSA◊ MRSA◊ GAS Oral anaerobes | Anaerobic coverage indicated for associated periodontal disease or poor dental hygiene Preferred in communities with low◊ prevalence of clindamycin-resistant S. aureus |
| Linezolid | <12 years: 30 mg/kg per day IV divided every 8 hours (maximum 1.8 g/day) ≥12 years: 20 mg/kg per day IV divided every 12 hours (maximum 1.2 g/day) | MSSA MRSA GAS | |
| Nafcillin | 150 to 200 mg/kg per day IV divided every 6 hours (maximum dose 12 g/day) | MSSA GAS | |
| Oxacillin | 150 to 200 mg/kg per day IV divided every 6 hours (maximum dose 12 g/day) | MSSA GAS | |
| Piperacillin-tazobactam¥ | 300 mg/kg per day IV divided every 6 or 8 hours (maximum dose 16 g/day of piperacillin component) | MSSA GAS Oral anaerobes Gram-negative organisms | Anaerobic coverage indicated for associated periodontal disease or poor dental hygiene |
| Vancomycin | 45 to 60‡mg/kg per day IV divided every 6 or 8 hours (maximum 4 g/day) | MSSA MRSA GAS | Preferred in communities with substantial◊ prevalence of clindamycin-resistant S. aureus |
GAS: group A Streptococcus; IV: intravenously; MRSA: methicillin-resistant S. aureus; MSSA: methicillin-susceptible Staphylococcus aureus.
* The doses recommended above are intended for patients with normal kidney function; the doses of some of these agents must be adjusted in patients with kidney function impairment.
¶ Dosed according to the amoxicillin or ampicillin component. The choice of which amoxicillin-clavulanate dosing regimen (every 8 hours or every 12 hours) to use is made based on availability of the various formulations and provider and caregiver preferences.
Δ This tablet is only for children who weigh ≥40 kg.
◊ The prevalence of clindamycin-resistant S. aureus varies geographically and may be more than 10% in some communities. The threshold prevalence of clindamycin-resistant S. aureus for choosing vancomycin varies from center to center, usually ranging from 10 to 25%, trying to balance the benefit of definitive therapy for the patient with the risk of increasing vancomycin resistance in the community.
§ Dosed according to the trimethoprim component.
¥ Dosed according to the piperacillin component.
‡ 60 mg/kg per day is recommended for children with serious infections (eg, toxic-appearing, fluctuant nodes, concomitant cellulitis). Adjustment of dose and frequency may be necessary based upon serum concentration monitoring.