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Amikacin N/A 15 mg/kg IVonce/day

or7.5 mg/kg q 12 h

15 mg/kg IV once/dayor

7.5 mg/kg IV q 12 h

N/A 57.5 mg/kg IVq 1 2 h

1.52.5 mg/kg IVq 2448 h

Gentamicin N/A 57 mg/kg IV

once/dayor1.7 mg/kg IV q 8 h

57 mg/kg

IV once/day

N/A 12.5 mg/kg IV

q 8 h

0.340.51 mg/kg IV

q 2448 h

For synergy with acell wallactiveantibiotic to treatenterococcalendocarditis causedby strains susceptibleto gentamicin

N/A 1 m g/kg IV q 8 h N/A N/A 1 mg/kg IV q 8 h Infectious diseaseconsultation requiredfor dosage

Dosage adjusted toachieve peak serumconcentration of 34g/mL and troughconcentration of < 1g/mL

TABLE 1703. USUAL DOSES OF COMMONLY PRESCRIBED ANTIBIOTICS

MERCK MANUALSONLINE MEDICAL LIBRARY

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Bacteria and Antibacterial Drugs

Introduction

THE

Drug Oral Parenteral Serious Infections Oral Parenteral

Dose in RenalFailure* (CrCl < 10

mL/min)

Adult DoseChildren's

(Age > 1 mo) Dose

For streptococcal orStaphylococcus aureusendocarditis

1 mg/kg IV q 8 hor

3 mg/kg IVonce/day

N/A N/A 1 mg/kg IV q 8 hor

3 mg/kg IV once/day

N/A

AMINOGLYCOSIDES

For hepatic coma 13 g qid N/A N/A 0.61.75 g/m2 q 6 hor

0.41.2 g/m2 q 4 h

N/A N/A

NeomycinFor preoperative gutantisepsis (witherythromycin andmechanical cleansing)

1 g for 3 doses (eg,at 1, 2, and 11 pmon the day beforesurgery)

N/A N/A 15 mg/kg q 4 hfor 2days

or25 mg/kg at 1, 2, and11 pm on the daybeforesurgery

N/A N/A

Table continues on the following page

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StreptomycinFor TB

N/A 15 mg/kg IM q24 h (maximum:1.0 g/day) initially,then 1.0 g 23times/wk

N/A N/A 2040 mg/kg IMonce/day

7.5 mg/kg IM q 7296h (maximum: 1 g)

For synergy with a cellwallactive antibiotic

to treat enterococcalendocarditis

N/A 7.5 mg/kg IMq 1 2 h

N/A N/A N/A N/A

Tobramycin N/A 57 mg/kg IVonce/day

or1.7 mg/kg IVq 8 h

57 mg/kg IVonce/dayor

1.7 mg/kgIV q 8 h

N/A 12.5 mg/kg IVq 8 h

0.340.51 mg/kg IV q2448 h

TABLE 1703. USUAL DOSES OF COMMONLY PRESCRIBED ANTIBIOTICSContinued


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Introduction

THE




mL/min)


(Age > 1 mo) Dose

b-LACTAMS: CEPHALOSPORINS (1ST GENERATION)

Cefotetan N/A 13 g IVq 12 h

23 g IVq 1 2 h

N/A 2040 mg/kg IVq 12 h

13 g IVq 4 8 h

Cefaclorb 0.250.5 g q 8 h N/A N/A 1020 mg/kg

q 1 2 hor

6.613.3 mg/kgq 8 h

N/A 0.5 g po q 12 h

Cephalexin 0.250.5 gq 6 h

N/A N/A 6.2512.5 mg/kgq 6 h

or8.016 mg/kgq 8 h

N/A 0.250.5 g poq 2448 h

Cefazolin N/A 12 g IV q 8 h 2 g IV q 8 h N/A 16.633.3 mg/kgIV q 8 h

12 g IVq 2448 h

Cefadroxil 0.51 gq 1 2 h

N/A N/A 15 mg/kg q 12 h N/A 0.5g po q 36 h

b-LACTAMS: CEPHALOSPORINS (2ND GENERATION)

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Cefoxitin N/A 1 g IV q 8 hto2 g I V q 4 h

2 g IV q 4 hor

3 g I Vq 6 h

N/A 2733 mg/kg IVq 8 h or, for severeinfections, 2540mg/kg q 6 h

0.51.0 g IVq 2448 h

Cefprozil 0.25g q 12 hor

0.5 g q 1224 h

N/A N/A 15 mg/kg q 12 hfor otitis media

N/A 0.25 g po q1224 h

Cefuroxime 0.1250.5 gq 1 2 h

0.751.5 g IVq 68 h

1.5 g IV q 6 h 1015 mg/kg suspen-sion q 12 h

For older children:125250 mgtablets q 12 h

2550 mg/kg IVq 8 h

0.250.5 g po q 24 hor

0.75 g IV q 24 h



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mL/min)


(Age > 1 mo) Dose

For meningitis 3 g IV q 8 h 5060 mg/kg IVq 6 h

Cefoperazone N/A 1 g q 12 h to2 g I V q 4 h

2 g IV q 4 h N/A 25100 mg/kg IVq 12 h

Same as adult dose

Cefotaxime N/A 1 g q 12 h to

2 g I V q 4 h

2 g IV q 4 h N/A 8.333.3 mg/kg IV

q 4 hor16.666.6 mg/kgq 6 h

12 g IV q 24 h

Cefpodoximec 0.10.4 g q 12 h N/A N/A 5 mg/kg q 12 h N/A 0.10.4 g po q

24 h

b-LACTAMS: CEPHALOSPORINS (3RD GENERATION)

Ceftazidime N/A 1 g IV q 12 h to2 g q 8 h


0.5 g IV q 2448 h

Ceftibutenb 0.4 g q 24 h N/A N/A 9 mg/kg once/day N/A 0.1 g po q 24 h

Ceftizoxime N/A 0.5 g IV q 12 hto

4 g I V q 8 h


0.5 g IV q 24 hto

0.51 g IV q 48 h

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Ceftriaxone N/A 12 g IV q 24 h 2 g IV q 24 h N/A 5075 mg/kg IVq 2 4 h

or2537.5 mg/kg q 12 h

Same as adult dose

For meningitis N/A 2 g IV q 12 h 2 g IV q 12 h N/A 50 mg/kg IV q 12 hor 100 mg/kg q 24 h(not to exceed

4 g/day)Possibly a loadingdose of 100 mg/kgIV (not to exceed 4g) at the start oftherapy

2 g IV q 12 h

Cefepime N/A 12 g IV q812 h


0.251 g IV q 24 h



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mL/min)


(Age > 1 mo) Dose

Amoxicillin/clavulanate,extended-release

2 g q 12 h N/A N/A N/A N/A N/A

Amoxicillin/clavulanate,ES-600

N/A N/A N/A 45 mg/kg q 12 h N/A N/A

Amoxicillin/clavulanate 0.250.5 g q 8 hor

0.875 gq 1 2 h

N/A N/A If> 40 kg,adult dose

N/A 0.250.5 g po q 24 h

b-LACTAMS: CEPHALOSPORIN (4TH GENERATION)

Amoxicillin 0.250.5 g q 8 hor

0.875 g

q 1 2 h

N/A N/A 12.525 mg/kgq 1 2 h

or

713 mg/kg q 8 h

N/A 0.250.5 g po q 24 h

For endocarditisprophylaxis

2 g for 1 dose N/A N/A 50 mg/kg 1 h beforeprocedure

N/A 2 g p o for 1 dose

b-LACTAMS: PENICILLINS

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Ampicillin N/A 0.52.0 g IVq 46 h


0.52.0 g IVq 1224 h

For meningitis N/A 2 g IV q 4 h 2 g IV q 4 h N/A 50100 mg/kg IVq 6 h

2 g IV q 12 h

Ampicillin/sulbactam

(3 g = 2 g ampicillin+ 1 g sulbactam)

N/A 1.53.0 g IV

q 6 h

3 g IV q 6 h N/A 2550 mg/kg IV

q 6 h

1.53.0 g IV

q 2 4 h



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mL/min)


(Age > 1 mo) Dose

Penicillin Gb 0.250.5 g

q 612 h(penicillin V)

14 million unitsIV q 46 h

4 million units IVq 4 h

Penicillin VK6.2512.5 mg/kgq 8 h

6,250100,000units/kg IV q 6 h

or4,166.666,666units/kg IV q 4 h

0.52 million units IVq 46 h(maximum total dailydose: 6 millionunits/day)

Oxacillin Rarely used 12 g IV q 4 h 2 g IV q 4 h N/A 12.525 mg/kg IVq 6 h

or

8.333.3 mg/kg IVq 4 h

12 g IV q 4 h

Dicloxacillinb 0.1250.5 g q 6 h N/A N/A 3.1256.25 mg/kg

q 6 hN/A 0.1250.5 g po

q 6 h

Nafcillin Rarely used 12 g IV q 4 h 2 g IV q 4 h N/A 12.525 mg/kg IVq 6 h

or8.333.3 mg/kgq 4 h

12 g IV q 4 h

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Piperacillin/tazobactam(2.25 g = 2.0 gpiperacillin + 0.25 gtazobactam)

N/A 3.375 g IVq 46 h

3.375 g IVq 4 h

N/A 80 mg/kg IV q 8 h 2.25 g IV q 8 hto 4.5 g IV q 12 h

Penicillin Gbenzathine (BicillinL-A)

For streptococcalpharyngitis

N/A 1.2 million unitsIM for1 dose

N/A N/A 25,00050,000 units/kgIM as a single dose

orif < 27 kg,300,000600,000 unitsas a single dose

orif 27 kg, 0.9 millionunits as a single dose

1.2 million units IMfor 1 dose

Prophylaxis forrheumatic fever

N/A 1.2 million unitsIM q 34 wk

N/A N/A 25,00050,000 units/kgIMq 34 wk

1.2 million units IMq 34 wk

For early syphilis N/A 2.4 million unitsIM for 1 dose

N/A N/A 50,000 units/kg IM for 1dose




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mL/min)


(Age > 1 mo) Dose

Piperacillin(1.9 mEq Na/g)

N/A 3 g IV q 46 h 3 g IV q 4 h N/A 5075 mg/kg IV q 6 hor

33.350 mg/kg IV q 4 h

34 g IV q 12 h

Penicillin G procaine

(IM only)

N/A 0.30.6 million

unitsIM q 12 h

N/A N/A 25,00050,000 units/kg

IM q 24 hor

12,50025,000 units/kgIM q 12 h

0.3 to 0.6 million

units IM q 12 h

For late syphilis(excluding neu-rosyphilis)

N/A 2.4 million unitsIM/wkfor 3 wk

N/A N/A 50,000 units/kg IM in 3doses 1 wk apart


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Ticarcillin(5.2 mEq Na/g)

N/A 3 g IV q 46 h 3 g IV q 4 h N/A If < 60 kg:50 mg/kg IVq 46 h

12 g IV q 12 h

Ticarcillin/clavulanate(3.1 g = 3 g ticarcillin +0.1 g clavulanic acid)

N/A 3.1 g IV q 46 h 3.1 g IV q 4 h N/A If < 60 kg:50 mg/kg IV (basedon ticarcillin

component) q 46 h

2 g IV q 12 h



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mL/min)


(Age > 1 mo) Dose

Aztreonam N/A 12 g IV q612 h


0.5 g IV q 8 h

Ertapenem N/A 1 g IV q 24 h 1 g IV q 24 h N/A N/A 0.5 g IV q 24 h

Imipenem N/A 0.51.0 g IV q 6 h 1 g IV q 6 h N/A For infants4 wk to 3 mo:25 mg/kg IV q 6 h

For children> 3 mo: 1525mg/kg IV q 6 h

0.1250.25 gIV q 12 h (mayincrease risk ofseizures)

OTHER b-LACTAMS

Meropenem N/A 1.0 g IV q 8 h 1.0 g IV q 8 h N/A 2040 mg/kg IVq 8 h

0.5 g IV q 24 h

For meningitis 40 mg/kg IV q 8 h 40 mg/kg IV q 8 h N/A 20 mg/kg IVq 2 4 h

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Ciprofloxacin 0.50.75 g q 12 h 0.20.4 g IVq 812 h

0.4 g IV q 8 h 1015 mg/kg IVq 12 h (in selectcircumstances)

1015 mg/kg IVq 12 h (in selectcircumstances)

0.50.75 g po q 24 hor

0.20.4 g IV q 24 h

Moxifloxacin 0.4 g q 24 h 0.4 g IV q 24 h 0.4 g IV q 24 h N/A N/A 0.4 g q 24 h po or IV

Norfloxacinb 0.4 g q 12 h N/A N/A N/A N/A 0.4 g po q 24 h

Ofloxacin 0.20.4 g q 12 h 0.4 g IV q 12 h 0.20.4 g IV q 12 h N/A N/A 0.10.2 g po or IVq 2 4 h



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Infectious Diseases


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mL/min)


(Age > 1 mo) Dose

FLUOROQUINOLONESD

Extended-release foruncomplicated cystitis

0.5 g q 24 h for 3days

N/A N/A N/A N/A N/A

Gemifloxacin 320 mg q 24 h N/A N/A N/A N/A 160 mg po q 24 h

Levofloxacin 0.250.75 g q 24 h 0.250.75 IV gq 2 4 h

0.75 g IV q 24 h N/A N/A 0.250.5 g po or IVq 4 8 h

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mL/min)


(Age > 1 mo) Dose

For otitis media orcommunity-acquiredpneumonia

N/A N/A N/A 10 mg/kg on day1, then 5 mg/kgonce/day on days25

N/A N/A

For tonsillitis orpharyngitis

N/A N/A N/A 12 mg/kg for 5 days N/A N/A

For nongonococcalcervicitis and urethritis

1 g for 1dose N/A N/A N/A N/A N/A

For travelers diarrhea 1 g for 1dose N/A N/A 510 mg/kg for 1dose

N/A N/A

Azithromycin 0.5 g on day 1,then 0.25 g q 24 hfor 4 days

0.5 g IV q 24 h 0.5 g IV q 24 h N/A 0.5 g on day 1, then0.25 g po q 24 h for4 daysor0.5 g IV q 24 h

MACROLIDES

Clarithromycin 0.250.5 g q 12 h

Extended-release: 1 g q 24 h

N/A N/A 7.5 mg/kg q 12 h N/A 0.250.5 g po q24 h

Dirithromycin 0.5 g q 24 h N/A N/A N/A N/A 0.5 g po q 24 h

Erythromycin baseb 0.250.5 g q 6 h N/A N/A 1016.6 mg/kg q 8 h

or

7.512.5 mg/kgq 6 h

N/A 0.25 g po q 6 h

Lactobionate N/A 0.51 g IV q 6 h 1 g IV q 6 h N/A 3.755.0 mg/kg IV

q 6 h

0.5 g IV q 6 h

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Telithromycin 800 mg

q 2 4 h

N/A N/A N/A N/A 800 mg po q 24 h

Sulfisoxazole 1.0 g q 6 h 25 mg/kg IV q 6 h(not availablein US)

N/A 3037.5 mg/kg q 6 hor

2025 mg/kg q 4 h

N/A 1 g po q 1224 h

Sulfamethizole 0.51 gq 68 h

N/A N/A 7.511.25 mg/kgq 6 h

N/A N/A

Sulfamethoxazole 1 g q 812 h N/A N/A 2530 mg/kg q 12 h N/A 1 g po q 24 h

Trimethoprim 0.1 g q 12 hor

0.2 g q 24 h

N/A N/A 2 mg/kg q 12 h for 10days for UTI

N/A 0.1 g po q 24 h

Trimethoprim/sulfamethoxazole

e0.16/0.8 gq 1 2 h

35 mg TMP/kgIV q 68 h

5 mg TMP/kgIV q 6 h

36 mg TMP/kgq 12 h

36 mg TMP/kgIVq 12 h

(Not recommended ifother alternatives areavailable)



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mL/min)


(Age > 1 mo) Dose

Gluceptate N/A 0.51 g IV q 6 h 1 g IV q 6 h N/A 3.755.0 mg/kg IVq 6 h

0.5 g IV q 6 h

For GI preoperativebowel preparation

1 g for 3 doses N/A N/A 20 mg/kg for 3 doses N/A N/A

SULFONAMIDES AND TRIMETHOPRIM

ForPneumocystisjirovecipneumonia

e

0.32/1.6 gq 8 h for 21 days

5 mg TMP/kg IV q8 h for 21 days

5 mg TMP/kgIV q 68 h

56.6 mg TMP/kg q8 h

or3.755 mg TMP/kgq 6 h

56.6 mg TMP/kg IVq 8 h

or3.755 mg TMP/kgIV q 6 h

If essential, 5 mgTMP/kg IV q 24 h

or1.25 mg TMP/kg IV q6 h

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mL/min)


(Age > 1 mo) Dose

Doxycycline 0.1 g q 12 h 0.1 g IV q 12 h 0.1 mg IV q 12 h Age > 8 yr: 24mg/kg q 24 h

or12 mg/kg q 12 h

Age > 8 yr: 24mg/kg IV q 24 h

or12 mg/kg IV q 12 h

0.1 g IV or po q 12 h

Minocycline 0.1 g q 12 h 0.1 g IV q 12 h 0.1 g IV q 12 h N/A N/A 0.1 g IV or po q 12 h

Tigecycline N/A 100 mg, then50 mg (25 mgfor severe hepaticdysfunction)IV q 12 hr

Same as adult dose N/A N/A Same as adult dose

Tetracyclineb 0.250.5 g q 6 h N/A N/A Age > 8 yr:

6.2512.5 mg/kg q6 h

N/A Doxycycline usedinstead

TETRACYCLINES

Clindamycin 0.150.45 g q 6 h 0.6 g IV q 6 hto 0.9 IV g q 8 h

0.9 g IV q 8 h 2.66.6 mg/kg q8 h

or25 mg/kg q 6 h

6.613.2 mg/kg IVq 8 h

or510 mg/kg IVq 6 h

0.150.45 g po q 6 hor

0.60.9 g IV q 68 h

Chloramphenicol 0.251 gq 6 h

0.251.0 g IVq 6 h

1 g IV q 6 h N/A 12.518.75 mg/kgIV q 6 h

0.251.0 g IVq 6 h

For meningitis N/A 12.5 mg/kg q 6 h(maximum: 4g/day)

12.5 mg/kgIV q 6 h (maxi-mum: 4 g/day)

N/A 18.7525 mg/kgIV q 6 h

12.5 mg/kg IV q 6 h(maximum: 4 g/day)

OTHERS

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mL/min)


(Age > 1 mo) Dose

Daptomycin N/A 4 mg/kg IVq 24 h

4 mg/kg IVq 24 h

N/A N/A 4 mg/kg IVq 48 h

Linezolid 0.6 g q 12 h 0.6 g IV q 12 h 0.6 g IV q 12 h 10 mg/kg q 8 h 10 mg/kg IV q 8 h 0.6 g IV or po q 12 h

For trichomoniasis 2 g for 1 doseor

0.5 g q 12 h for 7days

N/A N/A N/A N/A N/A

ForClostridiumdifficile-induceddiarrhea (pseudo-membranous colitis)

0.5 g q 68 h for1014 days

500 mg IVq 68 h

500 mg IV q 6 h 7.5 mg/kg q 8 h 7.5 mg/kg IVq 6 h

250 mg po or IV q 8 h

For amebiasis 0.50.75 g q 8 h for10 days followed by paromomycinpo 0.5 g q 8 h for7 days

0.75 g IV q 8 h for10 days followedby paromomycinpo 0.5 g q 8 h for7 days

0.75 g IV q 8 h for10 days followed byparomomycin po 0.5g q 8 h for 7 days

11.616.6 mg/kgq 8 h for 710 days

11.616.6 mg/kgIV q 8 h for 710days

N/A

For anaerobicinfection

7.5 mg/kg q 6 h(not to exceed4 g/day)

7.5 mg/kg IVq 6 h (not toexceed 4 g/day)

7.5 mg/kg IV q 6 h(not to exceed 4g/day)

7.5 mg/kg q 6 h 7.5 mg/kg IVq 6 h

3.75 mg/kg IV or po q6 h (not to exceed 2g/day)

Metronidazole

For giardiasis 0.25 g q 68 h for57 days

N/A N/A 5 mg/kgq 68 h for 5 days

N/A N/A

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Infectious Diseases


Introduction

THE




mL/min)


(Age > 1 mo) Dose

Nitrofurantoin macro-crystals

50100 mg q 6 h N/A N/A 1.251.75 mg/kgq 6 h

N/A Not recommended

Nitrofurantoin monohy-drate/macrocrystals

100 mg q 12 h N/A N/A N/A N/A N/A

Quinupristin/dalfopristin

N/A 7.5 mg/kgIV q 812 h

7.5 mg/kg IV q 8 h N/A 7.5 mg/kg IV q 12 hfor complicatedskin or skin struc-ture infection

or7.5 mg/kg q 8 h forserious infections

7.5 mg/kg IVq 812 h

For TB 0.6 g q 24 h 0.6 g IV q 24 h N/A 510 mg/kg q 12 hor1020 mg/kg q 24 h

1020 mg/kgIV q 24 h

0.30.6 g IV or po q24 h

For meningococcalexposure 0.6 g q 1 2 h for 4doses N/A N/A Age 1 mo: 10 mg/kgq 12 h for 2 daysAge < 1 mo: 5 mg/kgq 12 h for 2 days

N/A 0.6 g po q 12 h for 4doses

ForHaemophilusinfluenzae exposure

20 mg/kg q 24 hfor 4 days (not toexceed 600 mg q24 h)

N/A N/A 20 mg/kg q 24 hfor 4 days

Age < 1 mo: 10 mg/kgq 24 h for 4 days

N/A 20 mg/kg q 24 h for 4days (not to exceed600 mg q 24 h)

For staphylococcalinfections (used with a penicillin, cephalo-sporin, or vancomycin)

0.3 g q 8 hor

0.60.9 g q 24 h

0.3 g IV q 8 hor

0.60.9 g IVq 2 4 h

0.3 g IV q 8 hor

0.60.9 g IVq 24 h

0.3 g IV or po q 8 hor

0.60.9 g IV or po q24 h

Rifampinb

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Spectinomycin N/A 2 g IM for 1 dose N/A N/A N/A 2 g IM for 1 dose

Vancomycin 125 mg q 6 h (onlyeffective forC. difficileinduced

diarrhea

15 mg/kg q 12 h(often 1 g q 12)

15 mg/kg IVq 1 2 h

N/A 13 mg/kg IV q 8 hor

10 mg/kg q 6 h

0.51.0 g IVq wk

For meningitis N/A 1 g IV q 8 hor

1.5 g IV q 12 hf

1 g IV q 8 hor

1.5 g IV q 12 h

N/A 15 mg/kg IV q 6 h 15 mg/kg IVq wk



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THE

N/A =Not applicable; TMP= trimethoprim.aInitial loading dose should be equivalent to the usual dose for patients with normal renal function, followed by a dose adjusted for renal failure. Dosing adjust-

ments of aminoglycosides should be assisted by measuring peak (drawn 1 h after the start of a 30-min IV infusion) and trough (drawn 30 min before next dose)serum levels.b

Rate or extent of absorption is decreased when the drug is taken with food.cDosage should not exceed that for adults.

dThese drugs are generally avoided in children.

e

Dose is based on TMP.fIn addition, intrathecal or intraventricular vancomycin 1020 mg/day may be necessary, and dose may need to be adjusted to achieve trough CSF levels of 1020

g/mL.



mL/min)


(Age > 1 mo) Dose

antb table 170 3

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