Febrile Neutropenia Drug Summary

Last updated: 19 March 2026
Reviewed by

Aminoglycosides

Drug Dosage Remarks
Amikacin Neonate: Initially 10 mg/kg/day IM/IV in divided doses, then 15 mg/kg/day IM/IV divided 12 hourly
Children: 15-20 mg/kg/day IM/IV divided 8-12 hourly
Adult:15 mg/kg/day IM/IV divided 8-12 hourly
Consider high-dose extended-interval dosing 		Adverse Reactions
  • Ototoxic effects (irreversible ototoxicity resulting in hearing loss, dizziness, vertigo); Renal effects (reversible nephrotoxicity, acute renal failure has been reported usually when other nephrotoxic drugs have also been administered); Neuromuscular effects (neuromuscular blockade resulting in respiratory depression and muscular paralysis); Hypersensitivity reactions
Special Instructions
  • Ototoxicity and nephrotoxicity are most likely in geriatric, dehydrated patients, those with renal impairment and in patients who are receiving high doses or for long periods, who are also receiving or have received other ototoxic/nephrotoxic drugs
    • Consider monitoring of serum concentrations and/or peak serum concentrations/MIC ratio in these patients
  • Use with caution in patients with conditions associated with muscle weakness (eg myasthenia gravis, Parkinson’s), patients with pre-existing renal dysfunction, vestibular or cochlear impairment
Gentamicin Infants and neonates: 2.5 mg/kg IM/IV 8 hourly or 3 mg/kg IM/IV 12 hourly
Children: 1.5-2 mg/kg IM/IV 8 hourly or 6-7.5 mg/kg/day IM/IV divided 8 hourly
Adult: 3-5 mg/kg/day IM/IV divided 6-8 hourly
Consider high-dose extended-interval dosing
Tobramycin Children: 6-7.5 mg/kg/day IM/IV divided 8 hourly
Adult: 3-6 mg/kg/day IM/IV divided 6-8 hourly
Consider high-dose extended-interval dosing

Antifungals

Drug Dosage Remarks
Amphotericin B
(conventional/deoxycholate) 		0.25-1.5 mg/kg IV 24 hourly
(may be given every other day) 		Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal cramps, anorexia, GI bleeding, liver disorders); CV effects (hypertension, hypotension, arrhythmias); Dermatologic effects (rashes, flushing, anaphylactoid reactions); Metabolic effects (hypokalemia, hypomagnesemia); Hematologic effects (anemia, thrombophlebitis at injection site); Other effects (blurring of vision, tinnitus, hearing loss, headache, fever, chills, muscle and joint pain, malaise, pain at injection site, nephrotoxicity)
Special Instructions
  • Although anaphylaxis is rare, it is advisable to administer a test dose and observe the patient before starting treatment
  • To reduce febrile reactions, antipyretics and antihistamines may be given prior to Amphotericin B dose
  • Monitor patient for changes in liver function, renal function, serum electrolytes and hematologic status
    • If blood urea nitrogen (BUN) and creatinine (Cr) levels rises, decrease the dose of Amphotericin B or change to lipid formulation
  • Infuse drug slowly to avoid vein irritation and infusion-related adverse effects
  • Care should be taken not to confuse the dosage regimens for individual preparations
Amphotericin B (lipid complex) 5 mg/kg IV 24 hourly Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, GI hemorrhage, abdominal pain); CV effects (hypotension, cardiac arrest); Respiratory effects (respiratory failure, dyspnea, pneumonia); GU effect (renal failure); Other effects (headache, rash, bilirubinemia, hypokalemia, acidosis)
  • Nephrotoxicity and infusion-related hyperpyrexia, rigors and chills are reduced relative to Amphotericin B deoxycholate
Special Instructions
  • A test dose of 1 mg should be infused slowly for up to 10 minutes and the patient must be carefully observed for 30 minutes afterwards
  • Discontinue infusion immediately if symptoms of an anaphylactic reaction develop
  • Care should be taken not to confuse the dosage regimens for individual preparations
Amphotericin B (liposomal) 3 mg/kg IV 24 hourly
Triazoles
Fluconazole Neonates: Same as older children but given 72 hourly for neonates 2 weeks old and 48 hourly for 2-4 weeks old
Children: 3-12 mg/kg/day IV 24 hourly or 3-12 mg/kg PO 24 hourly
Adult: 200-400 mg PO 24 hourly or 400 mg IV 24 hourly on day 1 followed by 200-400 mg IV 24 hourly
Continue treatment for at least 14 days 		Adverse Reactions
  • GI effects (abdominal pain, diarrhea, flatulence, nausea/vomiting, taste disturbance, elevated LFTs)
Special Instructions
  • Use with caution in patients with renal and hepatic impairment
Itraconazole 200 mg PO 12-24 hourly x 15 days Adverse Reactions
  • GI effects (dyspepsia, abdominal pain, nausea, constipation, diarrhea, increased LFTs, hepatitis, cholestatic jaundice); CNS effects (headache; dizziness); Dermatologic effects (pruritus, rash, urticaria, angioedema); Other effects (alopecia, edema, hypokalemia with prolonged treatment)
Special Instructions
  • Use with caution in patients at risk for hepatic failure, hepatic impairment and renal insufficiency
  • In patients with hypochlorhydria, absorption may be improved by administering the drug with an acidic drink (eg cola)
Isavuconazole
(Prodrug: Isavuconazonium sulfate) 		372 mg IV/PO 8 hourly x 6 doses followed by 372 mg IV/PO 24 hourly Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, increased LFTs, constipation, diarrhea); Infusion-related effects (hypotension, chills, dizziness, paresthesia, hypoesthesia); Other effects (hypokalemia, cough, back pain, peripheral edema)
Special Instructions
  • IV infusion is administered for at least an hour
  • Contraindicated in patients with familial short QT syndrome
  • Use with caution in patients with hepatitis, cholestasis and hepatic failure
  • Monitor LFTs at the start and during the course of therapy
  • Stop treatment if signs and symptoms of liver disease develops
Posaconazole 300 mg PO 12 hourly on day 1
followed by 300 mg PO 24 hourly 		Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal pain, dyspepsia, anorexia, flatulence, dry mouth); CNS effects (headache, dizziness, insomnia, somnolence, paresthesia); Other effects (back pain, dry skin, fatigue, fever)
Special Instructions
  • Use with caution in patients at risk for cardiac arrhythmia
  • Monitor hepatic function
Voriconazole Loading dose: 6 mg/kg IV 12 hourly for the first 24 hours
Maintenance dose (prevention of breakthrough infection):
3-4 mg/kg IV 12 hourly 		Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal pain); Other effects (headache, peripheral edema, visual disturbances, fever, rashes)
  • Less common effects: Hepatic reactions have occurred, skin reactions including rare cases of erythema multiforme, etc
Special Instructions
  • Doses should be taken ≥1 hour before or 2 hours after a meal
  • Use with caution in patients with hepatic impairment
  • For patients affected by visual disturbances, driving or operating machinery should be avoided
  • Avoid sunlight during treatment as photosensitivity reactions have been reported
Other Systemic Antimycotics
Anidulafungin 200 mg IV as single dose followed by 100 mg IV 24 hourly Adverse Reactions
  • GI effects (nausea/vomiting, increased LFTs); Dermatologic effects (rash, facial swelling, pruritus, sensation of warmth); Other effects (flushing, headache, fever, venous complications around infusion site)
Special Instructions
  • Not to be administered as bolus injection; max infusion rate is 1.1 mg/min
  • Discontinue use if anaphylactic reactions occur
  • Monitor LFTs during therapy and in patients who develop abnormal LFTs
Caspofungin Children 12 months-17 years old:
70 mg/m2 IV as single loading dose on day 1 (not to exceed max dose of 70 mg/m2) followed by 50 mg/m2 IV 24 hourly
Adult:
70 mg IV as single loading dose on day 1 followed by 50 mg IV 24 hourly 		Adverse Reactions
  • GI effects (nausea/vomiting, increased LFTs); Other effects (flushing, headache, fever, venous complications around infusion site); Hypersensitivity effects (rash, facial swelling, pruritus, sensation of warmth)
Special Instructions
  • May need to reduce doses in patients with hepatic impairment
Micafungin Children:
<4 months old: 2 mg/kg IV infusion for 1 hour 24 hourly
≥4 months old, ≤40 kg:
1 mg/kg IV infusion for 1 hour 24 hourly
≥4 months old, >40 kg:
50 mg IV infusion for 1 hour 24 hourly
Adult and adolescent ≥16 years old:
>40 kg: 50 mg IV infusion for 1 hour 24 hourly
<40 kg: 1 mg/kg/day IV infusion for 1 hour 24 hourly 		Adverse Reactions
  • Hematologic effects (coagulopathy, hemolysis, hemolytic anemia, pancytopenia, thrombotic thrombocytopenic purpura); CV effects (arrhythmia, atrial fibrillation, cardiac arrest, cyanosis, hypotension, MI, tachycardia, injection site thrombosis, deep vein thrombosis, hypertension); GI effects (upper abdominal pain, dyspepsia); Hepatic effects (hepatocellular damage, hepatomegaly, jaundice, hepatic failure); CNS effects (convulsions, encephalopathy, intracranial hemorrhage, delirium); GU effects (anuria, hemoglobinuria, oliguria, acute renal failure, renal tubular necrosis); Respiratory effects (pneumonia, apnea, dyspnea, hypoxia, pulmonary embolism); Dermatologic effects (erythema multiforme, skin necrosis, urticaria); Other effects (sepsis, acidosis, anorexia, hyponatremia, arthralgia)
Special Instructions
  • Use with caution in patients with severe hepatic impairment, chronic hepatic disease
  • Monitor for evidence of worsening hepatic function and hemolysis or hemolytic anemia during therapy

Cephalosporins

Drug Dosage Remarks
Third Generation Adverse Reactions
  • Hypersensitivity effects (urticaria, pruritus, rash, anaphylaxis); GI effects (diarrhea, nausea/vomiting, rarely antibiotic-associated diarrhea/colitis); Other effect (candidal infections)
  • High doses may be associated with CNS effects (encephalopathy, convulsions); Hepatic and renal effects have occurred; Rarely hematologic effects
  • Prolonged prothrombin time (PT), prolonged activated partial thromboplastin time (APTT), and/or hypoprothrombinemia (with or without bleeding) have been reported and occur most frequently with N-methylthiotetrazole (NMTT) side chain-containing cephalosporins
Special Instructions
  • Use with caution in patients allergic to Penicillin, there may be 10% chance of cross-sensitivity
  • Use with caution in patients with renal impairment
Ceftazidime Neonate and children ≤2 months old:
25-60 mg/kg/day IM/IV divided 12 hourly
Children >2 months old, <40 kg:
150 mg/kg/day IM/IV divided 8 hourly
Adult and children ≥40 kg: 2 g IM/IV 8-12 hourly
Max dose: 6 g/day
Fourth Generation
Cefepime Children ≥2 months old up to 40 kg:
50 mg/kg IM/IV 8 hourly
Adult and children >40 kg: 2 g IM/IV 8 hourly x 7 days or until resolution of neutropenia
Max dose: 6 g/day
Cefpirome Adult: 1-2 g IV 12 hourly
Max dose: 4 g/day
Cephalosporin with Beta-lactamase Inhibitor
Cefepime/sulbactam Up to 9 g/day IV/IM divided 8-12 hourly depending on the severity of infection
Cefoperazone/sulbactam Children: 40-80 mg/kg/day IM/IV divided 6-12 hourly (1:1 ratio) or
30-60 mg/kg/day IM/IV divided 6-12 hourly (2:1 ratio)
Adult: 2-4 g/day IM/IV divided 8-12 hourly (1:1 ratio) or 1.5-3 g/day IM/IV divided 8-12 hourly (2:1 ratio)
Max dose: 4 g/day

Haemotopoietic Agents

Drug Dosage Remarks
Efbemalenograstim alfa-vuxw 20 mg SC once per chemotherapy cycle Adverse Reactions
  • GI effect (nausea); Hematologic effects (anemia, thrombocytopenia)
Special Instructions
  • Administer approximately 24 hours after cytotoxic chemotherapy
  • Do not administer within the period from 14 days before to 24 hours after administration of cytotoxic chemotherapy
  • Use with caution in patients with enlarged spleen/splenic rupture, acute respiratory distress syndrome (ARDS), sickle cell disease, glomerulonephritis, thrombocytopenia, capillary leak syndrome, breast cancer, lung cancer
  • Monitor CBC, platelet count, signs/symptoms of ARDS, myelodysplastic syndrome, acute myeloid leukemia (AML)
Eflapegrastim-xnst 13.2 mg SC once per chemotherapy cycle Adverse Reactions
  • GI effects (nausea, diarrhea); CNS effect (headache); Musculoskeletal effects (bone pain, myalgia, arthralgia, back pain); Other effects (fatigue, pyrexia, anemia, rash)
Special Instructions
  • Administer approximately 24 hours after cytotoxic chemotherapy
  • Do not administer within the period from 14 days before to 24 hours after administration of cytotoxic chemotherapy
  • Use with caution in patients with breast cancer, lung cancer, enlarged spleen, sickle cell disorders, kidney disease
  • Monitor CBC, platelet count, signs/symptoms of myelodysplastic syndrome, AML, ARDS
Filgrastim (Filgrastim-aafi,
Filgrastim-sndz,
Tbo-filgrastim)		 Starting dose:
5 mcg/kg SC 24 hourly
Dose may be increased by increments of 5 mcg/kg per chemotherapy cycle 		Adverse Reactions
  • GI effects (nausea/vomiting, constipation, oropharyngeal pain, diarrhea); Respiratory effects (cough, dyspnea, hemoptysis); Metabolic effects (decreased appetite, increased lactate dehydrogenase and uric acid, hyperuricemia); Dermatologic effects (rash, alopecia); Hematologic effects (leukocytosis, thrombocytopenia); Hepatic effects (increased blood alkaline phosphatase, γ-glutamyl transferase, aspartate aminotransferase); Other effects (musculoskeletal pain, asthenia, fatigue, mucosal inflammation, hypotension, dysuria, chest pain, headache)
Special Instructions
  • Should not be used to increase the dose of cytotoxic chemotherapy beyond established dosage regimens
  • Discontinue or reduce dose if leukocyte count rises to >70 x 109/L
  • Contraindicated in patients with severe congenital neutropenia who develop leukemia or have evidence of leukemic evolution, malignant cell growth
  • Use with caution in patients with vascular disorders, graft versus host disease, sickle cell disease, osteoporosis, recent history of lung infiltrates or pneumonia, those with substantially reduced myeloid progenitors, undergoing high-dose chemotherapy
Lenograstim Adult and children >2 years old:
150 mcg/m2/day (19.2 x 106 IU/m2/day) SC/30-min IV infusion in patients with body surface area of up to 1.8 m2 		Adverse Reactions
  • GI effects (stomatitis, diarrhea, abdominal pain, nausea/vomiting, constipation); Dermatologic effects (alopecia, injection site reaction, rash); Other effects (asthenia, septic episode, infection, headache, bone pain, fever)
Special Instructions
  • Intensification of cytotoxic chemotherapy beyond established regimens and concurrent administration with cytotoxic chemotherapy are contraindicated (should not be used during the 24-hour period preceding or following chemotherapy)
  • Discontinue if leukocyte count >50 x 109/L after expected nadir
  • Contraindicated in patients with myeloid malignancy
  • Use with caution in patients with myelodysplasia, acute or chronic myelogenous leukemia, any myeloid malignancy, severe hepatic or renal impairment
Lipegfilgrastim One 6-mg dose SC per chemotherapy cycle 24 hours following cytotoxic chemotherapy Adverse Reactions
  • Respiratory effects (interstitial pneumonia, pulmonary hemorrhage, hemoptysis); Dermatologic effects (alopecia, injection site reaction, skin reaction); Hepatic effects (splenomegaly, splenic rupture); CV effects (aortitis, capillary leak syndrome); Other effects (headache, GI upset, asthenia, hypokalemia, blood dyscrasia, glomerulonephritis, chest pain, musculoskeletal pain)
Special Instructions
  • Contraindicated in patients with myeloid malignancy
  • Discontinue if leukocyte count >50 x 109/L after expected nadir
  • Use with caution in patients with myelodysplasia, acute or chronic myelogenous leukemia, any myeloid malignancy, severe hepatic or renal impairment, sickle cell anemia, recent history of pulmonary infiltrates, pneumonia, fructose intolerance
  • Monitor CBC, spleen size and potassium levels
Molgramostim 5-10 mcg/kg/day (60,000-110,000 IU/kg) SC initiated 24 hours after last dose of chemotherapy and continued for 7-10 days
Max dose:
10 mcg/kg/day 		Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, anorexia, abdominal pain, stomatitis); Musculoskeletal effects (bone and musculoskeletal pain, myalgia); CNS effects (paresthesia, dizziness, headache, asthenia); Dermatologic effects (rash, pruritus); Other effects (injection site reaction, fever, chills, fatigue, rigors, dyspnea, transient hypotension, non-specific chest pain, increased sweating, peripheral edema)
Special Instructions
  • Contraindicated in patients with myeloid malignancy
  • Use with caution in patients with pre-malignant or malignant myeloid condition, pre-existing pulmonary disease, heart failure or fluid retention
  • Monitor CBC regularly
Pegfilgrastim (Pegfilgrastim-bmez,
Pegfilgrastim-cbqv,
Pegfilgrastim-jmdb)		 One 6-mg dose SC per chemotherapy cycle, given at least 24 hours following cytotoxic chemotherapy Adverse Reactions
  • Musculoskeletal effects (mild to moderate bone pain, arthralgia, myalgia); GI effect (nausea); Other effects (injection site pain, erythema non-cardiac chest pain)
Special Instructions
  • Should not be used to increase the dose of cytotoxic chemotherapy beyond established dosage regimens
  • Discontinue if signs of acute respiratory distress occur
  • Contraindicated in patients with rare hereditary problems of fructose intolerance
  • Use with caution in patients with AML, myelodysplastic syndrome, chronic myelogenous leukemia, secondary AML, <55 years old with cytogenetics t(15;17), sickle cell disease, and patients receiving chemotherapy associated with delayed myelosuppression (eg nitrosoureas)
Sargramostim 250 mcg/m2/day via IV infusion over 4 hours x 42 days as required Adverse Reactions
  • CV effects (transient hypotension, pleural and pericardial effusion, cardiac rhythm abnormalities); Dermatologic effects (flushing, rash); GI effects (abdominal pain, GI bleeding, hematemesis, nausea/vomiting); Other effects (bone and musculoskeletal pain, fever, chills, dyspnea, anaphylactic reactions, fatigue)
Special Instructions
  • Discontinue if patient develops signs of pulmonary infiltrates
  • Contraindicated in patients with excessive leukemic myeloid blasts in the bone marrow or peripheral blood (≥10%), and 24 hours before or after radiotherapy or chemotherapy
  • Use with caution in patients with fluid retention, heart failure, pulmonary disease, any pre-malignant or malignant myeloid condition, hypoxia
  • Monitor CBC, renal and hepatic function regularly during therapy

Other Antibiotics

Drug Dosage Remarks
Glycopeptides
Teicoplanin Neonate and infant:
<2 months old: 16 mg/kg IV as loading dose followed by 8 mg/kg IV 24 hourly
Children ≥2 months-12 years old:
10 mg/kg IV 12 hourly for first 3 doses then 6-10 mg/kg IV 24 hourly
Adult: 6 mg/kg IV 12 hourly for first 3 doses then reduce to 24 hourly 		Adverse Reactions
  • Hypersensitivity effects (fever, chills, skin rash, pruritus; anaphylaxis or bronchospasm, Stevens-Johnson syndrome); GI effects (GI disturbances); CNS effects (dizziness, headache); Hematologic effects; Hepatic effects; GU effects (renal impairment, less often than Vancomycin); Ototoxic effects (less frequently than with Vancomycin)
Special Instructions
  • Use with caution in patients with pre-existing renal dysfunction and monitor renal and auditory function if on prolonged therapy
  • Periodic monitoring of CBC and LFTs is advised
Vancomycin 20-35 mg/kg IV as loading dose followed by 15-20 mg/kg IV 8-12 hourly
or
15-20 mg/kg IV as loading dose followed by 30-60 mg/kg/day continuous IV infusion to achieve steady-state concentration of 20-25 mg/L 		Adverse Reactions
  • “Red neck syndrome” which is usually related to too rapid infusion: Flushing, erythema, rash over face and upper torso, sometimes hypotension and shock-like symptoms also occur
  • Hypersensitivity effects (anaphylactoid reactions, Stevens-Johnson syndrome); Hematologic effects; GU effect (nephrotoxicity may occur especially at high doses or in patients with predisposing factors); Ototoxic effects (ototoxicity which is more likely with high plasma concentrations or in renal impairment, may be irreversible; tinnitus may precede hearing loss and can be used as a sign to discontinue treatment)
Special Instructions
  • Avoid in patients with a history of impaired hearing
  • Use with caution in patients with impaired renal function and the elderly
  • Monitoring of serum concentrations may be done to help avoid renal and otic toxicity, monitoring of CBC and renal function during treatment is suggested along with monitoring of auditory function
Lincosamide
Clindamycin Children >1 month old:
8-40 mg/kg/day PO divided 6-8 hourly
Children <12 months old or <10 kg:
37.5 mg PO 8 hourly
Adult: 150-450 mg PO 6 hourly
Max dose: 1.8 g/day 		Adverse Reactions
  • GI effects (diarrhea, severe antibiotic-related pseudomembranous colitis, nausea/vomiting, abdominal pain, metallic taste); Hypersensitivity effect (rash, urticaria, rarely anaphylaxis); Dermatologic effects (erythema multiforme, exfoliative and vesiculobullous dermatitis); Hematologic and hepatic effects have occurred; Other effect (polyarthritis)
Special Instructions
  • Use with caution in patients with GI disease especially with history of colitis, renal or hepatic impairment and in atopic patients
  • Discontinue if diarrhea occurs
Other Antibacterials
Daptomycin 6 mg/kg/day IV 24 hourly Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, constipation); Hematologic effect (anemia); Dermatologic effect (rash)
Special Instructions
  • Use with caution in patients with renal impairment
  • Monitor creatine phosphokinase levels once weekly or more frequently in high-risk patients
  • Monitor for signs and symptoms of neuropathy
Linezolid Neonates ≤7 days:
10 mg/kg IV 8-12 hourly
Children 7 days-12 years old:
10 mg/kg IV (max of 600 mg) 8 hourly
Adult and children >12 years old:
600 mg IV/PO 12 hourly for 10-14 days (up to 28 days for resistant strains) 		Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, metallic taste, constipation); CNS effects (headache, dizziness, insomnia; convulsions have also been reported); Hematologic effects (reversible myelosuppression including anemia, leukopenia, pancytopenia and, in particular, thrombocytopenia); Other effects (rashes, fever, oral and vaginal candidiasis, abnormal LFTs)
  • Superficial discoloration of the teeth has occurred in some patients
  • Lactic acidosis has been reported
Special Instructions
  • CBC should be monitored weekly
  • Use with caution in patients with renal impairment

Other Beta-Lactams

Drug Dosage Remarks
Carbapenems
Imipenem/cilastatin Children: 15-25 mg/kg IV 6 hourly
Adult: 500 mg IV 6 hourly 		Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, antibiotic-associated diarrhea/colitis, tongue/tooth discoloration, altered taste); Hypersensitivity effects (rash, anaphylaxis); CNS effects (mental disturbances, confusion); Imipenem/cilastatin: Seizures and convulsions have been reported especially in patients with history of CNS lesions and/or renal dysfunction; Dermatologic effects (exfoliative dermatitis, Stevens-Johnson syndrome); Rarely hepatic effects; Other effect (candidal infections)
Special Instructions
  • Use with caution in patients allergic to penicillins, cephalosporins or other β-lactams, with renal impairment and in patients with CNS disorders (eg epilepsy)
Meropenem Children ≥3 month old, ≤50 kg:
20 mg/kg IV 8 hourly
Max dose: 1 g/day
Adult and children >50 kg:
1 g IV 8 hourly

Penicillins

Drug Dosage Remarks
Aminopenicillin with Beta-lactamase Inhibitor Adverse Reactions
  • Hypersensitivity effects (rash, urticaria, pruritus, anaphylaxis); GI effects (diarrhea, nausea/vomiting, rarely antibiotic-associated diarrhea/colitis); Other effect (candidal infections)
  • Rarely hematologic effects; Renal and hepatic effects have occurred; High doses may be associated with CNS effects (encephalopathy, convulsions)
Special Instructions
  • Avoid in patients with Penicillin allergy
  • Use with caution in patients with renal impairment
Co-amoxiclav (Amoxicillin/clavulanic acid, Amoxicillin/clavulanate) 500 mg (Amoxicillin) PO 8 hourly or
1 g (Amoxicillin) PO 12 hourly
Antipseudomonal Penicillins with or without Beta-lactamase Inhibitors
Azlocillin 2-5 g IV 8 hourly
Mezlocillin 200-350 mg/kg/day IV in divided doses
Max dose: 24 g/day
Piperacillin Children ≥1 month old: 300-400 mg/kg/day IM/IV divided 4-6 hourly
Adult: 200-300 mg/kg/day in divided doses or 12-18 g/day IM/IV divided 4-6 hourly
Max dose: 24 g/day
Piperacillin/tazobactam Children: 90 mg/kg slow IV infusion or injection 6 hourly in combination with an aminoglycoside
Max dose: 4.5 g/dose
Adult: 4.5 g slow IV infusion or injection 6 hourly in combination with an aminoglycoside
Ticarcillin 3 g IV 4 hourly
Ticarcillin/clavulanic acid Children ≥3 months old, <60 kg:
50 mg/kg/dose IV 4-6 hourly
Children ≥3 months old, ≥60 kg:
3.1 g IV 4-6 hourly
Adult <60 kg: 200-300 mg/kg/day (Ticarcillin) IV divided 6 hourly
Adult ≥60 kg: 3.1 g 4-6 hourly

Quinolone

Drug Dosage Remarks
Ciprofloxacin 750 mg PO 8-12 hourly or 400 mg IV 8-12 hourly Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal pain, dyspepsia, diarrhea, rarely antibiotic-associated diarrhea/colitis); CNS effects (headache, dizziness, sleep disorders, restlessness, drowsiness); Dermatologic effects (rash, pruritus, photosensitivity); Hypersensitivity effects (rash, Stevens-Johnson syndrome)
  • Rarely hematologic effects, hepatic and renal effects
  • Some quinolones have the potential to prolong the QT interval
Special Instructions
  • Administer at least 2 hours before or 3 hours after Al- or Mg-containing antacids, dietary supplements containing Zn or Fe or buffered didanosine preparations
  • Avoid exposure to strong sunlight or tanning beds
  • Use with caution in patients with epilepsy or history of CNS disorders, in patients with impaired renal or hepatic function and in those with glucose-6-phosphate dehydrogenase deficiency

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

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