Urinary Tract Infection (Pediatric) Drug Summary

Last updated: 30 August 2026
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Aminoglycosides

Drug Dosage Remarks
Amikacin 5-15 mg/kg/day IM/IV divided 8-12 hourly
Neonate: 10 mg/kg/day loading dose followed by 15 mg/kg/day divided 12 hourly
Max dose: 1.5 g/day 		Adverse Reactions
  • Ototoxic effects (can cause 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 patients with renal impairment, in patients who are receiving high doses or for long periods or who are also receiving or have received other ototoxic/nephrotoxic drugs
    • Consider monitoring of serum concentration and/or peak serum concentration/MIC ratio in these patients
  • Use with caution in neonates due to renal immaturity, patients with conditions associated with muscle weakness, with pre-existing renal dysfunction, with vestibular or cochlear impairment
Bekanamycin 10-20 mg/day IM divided 12 hourly
Gentamicin 3-7.5 mg/kg/day IM/IV divided 8-12 hourly
or
5-6 mg/kg/day IM/IV 24 hourly
Kanamycin 15 mg/kg/day IM divided 6-12 hourly
Max dose: 500 mg/day
Netilmicin Premature and full-term neonate <1 week old:
6 mg/kg/day IM/IV divided 12 hourly
Neonate >1 week-1 year old:
7.5-9 mg/kg/day IM/IV divided 8 hourly
>1 year old: 6-7.5 mg/kg/day IM/IV divided 8 hourly
Tobramycin 6-7.5 mg/kg/day IM/IV divided 6-8 hourly
or
5-6 mg/kg/day IM/IV 24 hourly

Antibacterial Combinations

Drug Dosage Remarks
Co-trimoxazole
[Sulfamethoxazole (SMZ) and
Trimethoprim (TM)] 		6-12 mg/kg/day PO divided 12 hourly based on TM Adverse Reactions
  • GI effects (nausea/vomiting, anorexia, diarrhea, rarely antibiotic-associated diarrhea/colitis, glossitis, stomatitis); Dermatologic effects (rash, pruritus, photosensitivity); Hypersensitivity reactions can range from mild (eg rash) to severe/life-threatening (eg Stevens-Johnson syndrome); Urogenital effect (crystallization in the urine)
  • Rarely hematologic effects which may be more common if given for long periods or with high doses; Rarely hepatic, and renal effects; Aseptic meningitis has occurred
Special Instructions
  • Maintain adequate fluid intake
  • Contraindicated in patients <2 months of age and patients with sulfonamide allergy
  • Use with extreme caution or not at all in patients with hematological disorders especially megaloblastic anemia due to folic acid deficiency
  • Use with caution in patients with renal impairment or severe hepatic dysfunction and in patients with folate deficiency (may consider administration of Ca folinate)
  • Use with caution in patients with G6PD deficiency

Cephalosporins

Drug Dosage Remarks
First Generation
Cefadroxil 25-50 mg/kg/day PO single dose or divided 12 hourly
May be increased to 100 mg/kg 		Adverse Reactions
  • Hypersensitivity reaction (urticaria, pruritus, severe reactions [eg anaphylaxis] can occur); GI effects (diarrhea, nausea/vomiting, rarely antibiotic-associated diarrhea/colitis); Other effects (candidal infections, injection site inflammation)
  • High doses may be associated with CNS effects (encephalopathy, convulsions); Rarely hematologic, hepatic and renal effects have occurred
  • Prolonged prothrombin time (PT), prolonged activated partial thromboplastin time (APTT), and/or hypoprothrombinemia (with or without bleeding time) have been reported and occurs most frequently with   N-methylthiotetrazole (NMTT) side chain containing cephalosporins
Special Instructions
  • May be taken with food to decrease gastric distress
  • Ceftriaxone is contraindicated in hyperbilirubinemic neonates
  • Avoid simultaneous administration of Ceftriaxone with IV Ca-containing solution
  • Use suspension containing Sodium benzoate with caution in neonates as this has been associated with gasping syndrome
  • Use with caution in patients allergic to Penicillin, there may be 10% chance of cross sensitivity; and in patients with renal impairment and GI disease especially with history of colitis

 
Cefalexin 25-100 mg/kg/day PO divided 6 hourly
Max dose: 4 g/day
Cefazolin 20-50 mg/kg/day IM/IV divided 6-12 hourly
Max dose: 100 mg/kg/day
Second Generation
Cefaclor >1 month old: 20-40 mg/kg/day PO divided 8 hourly
Max dose: 1 g/day
Cefamandole 50-100 mg/kg/day IM/IV divided 4-8 hourly
Severe infections: 150 mg/kg/day
Cefprozil >12 years old: 500 mg PO 24 hourly
Cefuroxime 10 mg/kg PO 12 hourly
Max dose: 500 mg/day
30-100 mg/kg/day IM/IV divided 6-8 hourly
Third Generation
Cefdinir 14 mg/kg/day PO 24 hourly or divided 12 hourly
Cefixime ≥6 months old: 1.5-3 mg/kg PO 12 hourly
>12 years old: 100 mg PO 24 hourly
Severe infections: 6 mg/kg PO 12 hourly
Cefoperazone 25-200 mg/kg/day IM/IV divided 6-12 hourly
Max dose: 12 g/day
Neonate <8 days: 50-200 mg/kg/day IM/IV divided 12 hourly
Cefotaxime Premature and newborn:
50 mg/kg/day IM/IV divided 12 hourly
1 month-12 years old:
50-100 mg/kg/day IM/IV divided 6-12 hourly
>12 years old: 1 g IM/IV 12 hourly
Severe infections: 150-200 mg/kg/day
Max dose: 12 g/day
Cefpodoxime 8-10 mg/kg PO 12 hourly
Ceftazidime 30-100 mg/kg/day IM/IV divided 8-12 hourly
Max dose: 6 g/day
Ceftriaxone Neonate: 20-50 mg/kg IM/IV 24 hourly
Max dose: 50 mg/kg/day
Children and Infant: 20-80 mg/kg IM/IV 24 hourly
Max dose: 80 mg/kg/day
Fourth Generation
Cefepime 1-2 months old: 30 mg/kg IM/IV 8-12 hourly
>2 months old and ≤40 kg:
50 mg/kg IM/IV 8-12 hourly
Cephalosporin with Beta-lactamase Inhibitor
Cefoperazone/sulbactam Vial 1 gram
40-80 mg/kg/day IM/IV divided 6-12 hourly
(1:1 Ratio)
Severe infections: 160 mg/kg/day IM/IV divided 6-12 hourly
Vial 1.5 gram
30-60 mg/kg/day IM/IV divided 6-12 hourly
(2:1 Ratio)
Severe infections: 240 mg/kg/day IM/IV divided 6-12 hourly

Other Antibiotics

Drug Dosage Remarks
Nitrofuran Derivatives
Nitrofurantoin >1 month old: 5-7 mg/kg/day PO divided 6 hourly
Long-term UTI prophylaxis:
1 mg/kg/day PO single dose
or divided 12 hourly
Max dose for UTI prophylaxis:
100 mg/day 		Adverse Reactions
  • GI effects (nausea/vomiting, abdominal pain, diarrhea, anorexia, rarely Clostridioides difficile-associated diarrhea/colitis); CNS effects (dizziness, drowsiness, fatigue, headache, rarely irreversible peripheral polyneuropathy); Hypersensitivity reactions (rash, angioedema, Stevens-Johnson syndrome, exfoliative dermatitis, pancreatitis, etc); Respiratory effects (acute pulmonary sensitivity reactions have occurred including pulmonary fibrosis); Hematologic effects, hepatic effects, and neuromuscular effects (arthralgia, numbness, paresthesia, weakness) have occurred; Ocular effects (amblyopia, nystagmus, optic neuritis)
Special Instructions
  • Take with food to decrease GI effects
    • Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake
  • Avoid in patients with renal impairment, and in patients with G6PD deficiency
  • Use with caution in the elderly and in patients with pre-existing pulmonary, hepatic, neurological or allergic disorders, and in those with conditions (eg anemia, DM, electrolyte imbalance, debility or vitamin B deficiency) which may predispose to peripheral neuropathy
  • Withdraw if signs of peripheral neuropathy develop

Penicillins

Drug Dosage Remarks
Aminopenicillins with or without Beta-lactamase Inhibitors
Amoxicillin 20-40 mg/kg/day PO divided 8 hourly Adverse Reactions
  • Hypersensitivity reactions (rash, urticaria, pruritus, severe reactions [eg anaphylaxis] can occur); GI effects (diarrhea, nausea/vomiting, rarely antibiotic-associated diarrhea/colitis); Other effect (candidal infections)
  • Rarely hematologic, renal and hepatic effects; 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
Amoxicillin/clavulanic acid
(Co-amoxiclav,
Amoxicillin/clavulanate) 		20-40 mg/kg/day PO divided 8 hourly based on Amoxicillin
≤3 months old: 25-30 mg/kg IV 8-12 hourly
3 months-12 years old: 25-30 mg/kg IV 6-8 hourly
Amoxicillin/sulbactam <2 years and nursing infant:
5 mL 8 hourly or 7.5 mL 12 hourly
Children 2-6 years old: 10 mL 8 hourly
Children >20 kg: 10-20 mL 8-12 hourly
FC Tab Children ≥12 years old:
500 mg PO 8 hourly
Suspension 40-100 mg/kg/day 8-12 hourly
Injection 1 year old or older weighing ≤40 kg: 60-150 mg/kg/day IV/IV infusion 8 hourly
May be increased to 150 mg/kg/day for severe infections
Max dose: 4 g Sulbactam/8 g Amoxicillin 24 hourly
Ampicillin 50-100 mg/kg/day PO divided 6 hourly or
50-100 mg/kg/day IM/IV divided 6 hourly
Ampicillin/sulbactam
(Sultamicillin) 		<30 kg: 25-50 mg/kg/day PO divided 12 hourly based on Ampicillin or
150 mg/kg/day IM/IV divided 6-8 hourly
Antipseudomonal Penicillins with or without Beta-lactamase Inhibitors
Piperacillin <7 days old/<2 kg: 150 mg/kg/day IV/IM in 3 divided doses
>7 days old and >2 kg: 300 mg/kg/day IV/IM in 3-4 divided doses
1 month-12 years old: 100-300 mg/kg/day IV/IM in 3-4 divided doses
Piperacillin/tazobactam Neonate <7 days old or <2 kg:
150 mg/kg/day IV in 3 divided doses
Neonate >7 days old or >2 kg:
300 mg/kg/day IV in 3-4 divided doses
Children 1 month - 12 years old: 100-300 mg/kg/day IV in 3-4 divided doses
May be administered as slow IV injection over 3-5 minutes or as IV infusion over 20-40 minutes

Quinolones

Drug Dosage Remarks
Ciprofloxacin 10-30 mg/kg/day PO divided 12 hourly
Max dose: 1.5 g/day
7.5-16 mg/kg/day IV divided 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 reactions can range from mild (eg rash) to severe/life-threatening (eg Stevens-Johnson syndrome)
  • Rarely hematologic, 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 ddI 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
Nalidixic acid 50 mg/kg/day PO divided 6 hourly

Sulphonamides

Drug Dosage Remarks
Sulfafurazole
(Sulfisoxazole) 		Initial dose: >2 months old:
75 mg/kg/day PO in divided doses
Maintenance dose: >2 months old:
150 mg/kg/day PO in divided doses
Max dose: 6 g/day 		Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, anorexia); Dermatologic effects (rash, pruritus, photosensitivity); CV effects (myocarditis, vasculitis) Hepatic effects (liver necrosis, hepatomegaly, jaundice); Metabolic effects (hypoglycemia, hypothyroidism); Other effects (hypersensitivity reactions, serum sickness-like syndrome)
  • Potentially fatal: Blood dyscrasias, Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylaxis
Special Instructions
  • Contraindicated in patients with severe renal or hepatic failure, blood disorders, acute porphyria and infants ≤2 months old
  • Adequate fluid intake is necessary to reduce risk for crystalluria
  • Use with caution in patients with impaired renal or hepatic function, history of allergy/asthma, AIDS, G6PD deficiency, SLE

Disclaimer

All dosage recommendations are for children 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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