Aminoglycosides

Drug	Dosage	Remarks
Amikacin	3 months-17 years old: 15-22.5 mg/kg/day IV divided 8-12 hourly Adult: 15 mg/kg/day IM/IV divided 8-12 hourly Max dose: 1.5 g/day	Adverse Reactions Ototoxic effects (irreversible ototoxicity: Hearing loss, dizziness, vertigo); Renal effects (reversible nephrotoxicity, acute renal failure); Neuromuscular effects (neuromuscular blockade resulting in respiratory depression/muscular paralysis) Special Instructions Ototoxicity and nephrotoxicity occur most likely among geriatric, dehydrated patients, those with renal impairment, 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 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 disease), pre-existing renal dysfunction and vestibular or cochlear impairment
Gentamicin	Children and adolescents: 2-2.5 mg/kg/dose IV 8 hourly Adult: 3-5 mg/kg/day IM/IV divided 6-8 hourly
Netilmicin	Infants and neonates >1 week old: 7.5-9 mg/kg/day IM/IV divided 8 hourly Children: 6-7.5 mg/kg/ day IM/IV divided 8 hourly Adult: 4-6 mg/kg/day IM/IV divided 8-12 hourly May be given up to 7.5 mg/kg/day IM/IV divided 8 hourly
Sisomicin	3 mg/kg/day IM/IV divided 8-12 hourly

Antibacterial Combinations

Drug

Dosage

Remarks

Co-trimoxazole
(Sulfamethoxazole [SMZ] and
Trimethoprim [TM])

3 months-17 years old:
8-20 mg/kg/day IV divided 6-12 hourly
Adult: 3.5-4 mg/kg/ dose IV 8-12 hourly

Adverse Reactions

GI effects (nausea/vomiting, diarrhea, anorexia); Hypersensitivity reactions (skin reactions, urticaria); Renal effect (renal failure)
Potentially fatal effects (Stevens-Johnson syndrome, agranulocytosis, toxic epidermal necrolysis, hepatic necrosis)

Special Instructions

Contraindicated in patients with hypersensitivity to Sulfamethoxazole and Trimethoprim
Not for infants <4 week old, pregnant or lactating patients and in patients with severe renal or hepatic insufficiency and megaloblastic anemia
Use with caution in patients with severe allergy or atopy, bronchial asthma, thyroid disorders, G6PD deficiency, potential folate deficiency

Cephalosporins

Drug	Dosage	Remarks
First Generation		Adverse Reactions Hypersensitivity reactions (urticaria, pruritus, rash, anaphylaxis); GI effects (diarrhea, nausea/vomiting); Other effect (candidal infections) High doses may be associated with CNS effects (encephalopathy, convulsions) 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 side chain-containing cephalosporins Special Instructions May be taken with food to decrease gastric distress Use with caution in patients allergic to Penicillin since there may is a 10% chance of cross-sensitivity and in those with renal impairment
Cefadroxil	<40 kg: 25-50 mg/kg/day PO divided 12 hourly >40 kg: Same as adult dose Adult: 1-2 g PO 24 hourly or divided 12 hourly
Cefalexin (Cephalexin)	Children: 25-100 mg/kg/day PO divided 6-12 hourly Max dose: 4 g/day Adult: 250-500 mg PO 6-8 hourly Max dose: 6 g/day
Cefalotin (Cephalotin)	Children: 80-160 mg/kg/day IM/IV divided 4-6 hourly Adult: 0.5-1 g IM/IV 4-6 hourly Max dose: 12 g/day
Cefazolin	>1 month: 25-50 mg/kg/day IM/IV divided 6-8 hourly Adult: 1-2 g/day IV divided 8 hourly
Cefradine (Cephradine)	Children: 25-50 mg/kg/day PO divided 6-12 hourly Max dose: 4 g/day or 50-100 mg/kg/day IM/IV divided 6 hourly Max dose: 200-300 mg/kg/day Adult: 1-2 g/day PO divided 6-12 hourly Max dose: 4 g/day or 2-4 g/day IM/IV divided 6 hourly Max dose: 8 g/day
Second Generation
Cefamandole	>1 month old: 50-100 mg/kg/day IM/IV divided 4-8 hourly May increase dose to 150 mg/kg/day Adult: 500-2,000 mg IM/IV 4-8 hourly
Cefotiam	0.5-2 g/day IM/IV divided 6-12 hourly May increase dose to 6 g/day or 200-400 mg PO 12 hourly
Cefoxitin	1-<4 weeks old: 20-40 mg/kg IM/IV 8 hourly >4 weeks old: 20-40 mg/kg IM/IV 6-8 hourly Adult: 1-2 g IM/IV 8 hourly May increase dose to 3 g IM/IV 6 hourly Max dose: 12 g/day
Ceftizoxime	≥6 months old: 50 mg/kg IM/slow IV injection over 3-5 minutes 6-8 hourly Adult: 1-2 g IM/slow IV injection over 3-5 minutes 8-12 hourly Severe infection: 2-4 g IV 8 hourly Max dose: 2 g IV 4 hourly
Cefuroxime	>3 months old: 50 mg/kg IM/IV 8 hourly Max dose: 1.5 g/dose Adult: 1.5 g IV 8 hourly
Third Generation
Cefoperazone	Infant and children: 50-200 mg/kg/day IM/IV divided 12 hourly Max dose: 300 mg/kg/day Adult: 1-2 g IM/IV 12 hourly Max dose: 8 g/day
Cefotaxime	>28 days-11 years old, <50 kg: 50-200 mg/kg/day IM/IV divided 4-12 hourly 12-18 years old or ≥50 kg: Same as adult dose Max dose: 200 mg/kg/day Adult: 1-2 g IM/IV 8-12 hourly Max dose: 12 g/day
Ceftazidime	0-2 months old: 25-60 mg/kg/day IV divided 12 hourly >2 months old: 30-100 mg/kg/day IV divided 8-12 hourly Max dose: 6 g/day Adult: 1-6 g/day IV divided 8-12 hourly Max dose: 9 g/day
Ceftriaxone	<15 days old: 20-50 mg/kg IM/IV 24 hourly Max dose: 50 mg/kg/day 15 days-12 years old, <50 kg: 50-100 mg/kg IM/IV 24 hourly Max dose: 4 g/day 12 years old, ≥50 kg: Same as adult dose Adult: 1-4 g IV 24 hourly Max dose: 4 g/day
Fifth Generation
Ceftaroline	Complicated skin and soft tissue infections: Neonates-<2 months old: 6 mg/kg IV 8 hourly 2 months old-<2 years old: 8 mg/kg IV 8 hourly 2-<12 years old: 12 mg/kg IV 8 hourly 12-<18 years old, <33 kg: 12 mg/kg IV 8 hourly 12-<18 years old, ≥33 kg: Same as adult dose Adult: 600 mg 12 hourly via IV infusion over 60 minutes x 5-14 days
Cephalosporin with Beta-lactamase Inhibitor
Cefoperazone/sulbactam	Children: 40-80 mg/kg/day IV divided 6-12 hourly Max dose: 80 mg/kg/day Sulbactam Adult: 2-4 g/day IV divided 12 hourly Max dose: 8 g/day (4 g of Cefoperazone)
Ceftriaxone/sulbactam	≥18 years old: 1-2 g IM/IV 12-24 hourly Max dose: 4 g/day

Other Antibiotics

Glycopeptides
Drug	Dosage	Remarks
Teicoplanin	≤2 months old Loading dose: 16 mg/kg IV single dose on day 1 Maintenance dose: 8 mg/kg/day IM/IV on day 2 2 months -12 years old Loading dose: 10/mg/kg 12 hourly for 3 doses Maintenance dose: 6-10 mg/kg/day IM/IV >12 years old: Same as adult dose Adult Loading dose: 12 mg/kg IM/IV 12 hourly for 3-5 doses Maintenance dose: 12 mg/kg IM/ IV 24 hourly	Adverse Reactions Dermatologic effects (skin rash, pruritus); Hypersensitivity reaction (Stevens-Johnson syndrome, occasionally anaphylaxis, bronchospasm); CNS effects (dizziness, headache); GI effect (GI disturbances); Renal effects (renal impairment, but less often than Vancomycin); Ototoxic effects (occurred but less frequently than with Vancomycin); Other effects (fever, chills) Special Instructions Use with caution in patients with pre-existing renal dysfunction Monitor renal and auditory function if on prolonged therapy Periodic monitoring of CBC and LFT is advised
Vancomycin	1 month-<12 years old: 10-15 mg/kg IV 6 hourly ≥12 years old: Same as adult dose Adult: 15-20 mg/kg IV 8-12 hourly Max dose: 2 g/dose Max rate: 10 mg/minute	Adverse Reactions “Red neck syndrome” which is usually related to too rapid infusion: Flushing, erythema, rash over the face and upper torso Sometimes hypotension and shock-like symptoms may also occur Hypersensitivity reactions (anaphylactoid reactions, Stevens-Johnson syndrome); Renal effect (nephrotoxicity); Ototoxic effect (tinnitus) Special Instructions Avoid in patients with a history of impaired hearing Use with caution in patients with impaired renal function, elderly, premature neonates and young infants because of their renal immaturity and their potential to have increased serum concentrations Monitoring of serum concentrations may be done to help avoid renal and otic toxicity, as well as monitoring of CBC and renal function during treatment is suggested along with monitoring of auditory function
Imidazole Derivative
Metronidazole	500 mg PO/IV 8-12 hourly	Adverse Reactions GI effects (metallic taste, nausea/vomiting, GI disturbance, diarrhea, abdominal pain, constipation); CNS effects (drowsiness, dizziness, headache, ataxia, confusion, depression, insomnia); Dermatologic effects (urticaria, angioedema, pruritus, erythema multiforme); Genitourinary effects (dysuria, cystitis, polyuria, incontinence, dark/reddish brown urine) Special Instructions Use with caution in patients with CNS disease, history of blood dyscrasia Disulfiram-like reactions may occur with concomitant alcohol ingestion
Lincosamides
Clindamycin	3 months-17 years old: 30-40 mg/kg/day IV divided 6-8 hourly or 8-25 mg/kg/day PO divided 6-8 hourly Adult: 1.2-2.7 g/day IM/IV divided 6-8 hourly or 300-450 mg PO 6 hourly	Adverse Reactions GI effects (diarrhea, severe antibiotic-related pseudomembranous colitis, nausea/vomiting, abdominal pain, metallic taste); Hypersensitivity reactions (rash, urticaria); Dermatological effects (erythema multiforme, exfoliative/vesiculobullous dermatitis); Other effect (polyarthritis) Special Instructions Use with caution in patients with GI disease especially those with history of colitis, known atopic dermatitis and renal or hepatic impairment Discontinue if diarrhea occurs
Lincomycin	≥1 month old: 10-20 mg/kg/day IM/ IV in divided doses or 30-60 mg/kg/day PO in divided doses Adult: 600 mg IM 12-24 hourly or 600 mg IV 8-12 hourly or 500 mg PO 6-8 hourly
Lipopeptide
Daptomycin	1-6 years old: 12 mg/kg IV 24 hourly 7-11 years old: 9 mg/kg IV 24 hourly 12-17 years old: 7 mg/kg IV 24 hourly Adult: 6 mg/kg via IV infusion 24 hourly x 8 weeks	Adverse Reactions GI effects (abdominal pain, diarrhea, nausea/vomiting, flatulence, bloating, distention, constipation); CNS effects (dizziness, headache, anxiety, insomnia); Dermatologic effects (pruritus, rash, infusion site reaction); Hepatic effects (increased CPK, ALT, AST, alkaline phosphatase); Other effects (asthenia, pyrexia, hypertension, hypotension) Special Instructions Use with caution in patients with GI disease especially those with history of colitis Monitor CPK and renal function weekly if with muscle pain or weakness of the extremities Discontinue if myopathy with CPK elevations of >1,000 U/L, CPK levels of >2,000 U/L or Clostridium difficile-associated diarrhea occurs
Oxazolidinone
Linezolid	1 month-11 years old: 10 mg/kg IV 8 hourly ≥12 years old: 600 mg IV 12 hourly	Adverse Reactions GI effects (diarrhea, nausea/vomiting, constipation, taste alteration, tongue discoloration, oral moniliasis); Genitourinary effect (vaginal moniliasis); CNS effects (dizziness, headache, insomnia); Dermatologic effect (rash); Hepatic effect (abnormal LFTs); Other effects (fever, fungal infection) Special Instructions Contraindicated in patients with uncontrolled hypertension, thyrotoxicosis, pheochromocytoma and patients taking sympathomimetics, vasopressors or antidepressants Use with caution in patients with history of seizures, DM, liver cirrhosis Monitor CBC weekly and for signs and symptoms of pseudomembranous colitis
Phosphonic Acid Derivative
Fosfomycin	Neonates 40-44 weeks old: 200 mg/ kg/day IV divided 8 hourly 1-<12 months old, <10 kg: 200-300 mg/kg/day IV divided 8 hourly 1-<12 years old, <10-40 kg: 200-400 mg/kg/day IV divided 6-8 hourly ≥12 years old, ≥40 kg: Same as adult dose Adult: 12-24 g/day IV divided 8-12 hourly	Adverse Reactions GI effects (stomatitis, nausea/vomiting, abdominal pain, diarrhea, anorexia, oral dryness); CNS effects (headache, perioral numbness, convulsions, vertigo); Hematologic effects (agranulocytosis, granulocytopenia, eosinophilia); Hepatic effect (reversible increase in liver enzymes); Respiratory effects (cough, asthma attack); Other effect (phlebitis) Special Instructions Contraindicated in patients with severe renal impairment Use with caution in patients with cardiac insufficiency, hypertension, hyperaldosteronism, hypernatremia Administer with caution in patients whose parents or siblings have a predisposition to develop allergic reactions (eg bronchial asthma, rash and urticaria) Perform hematological tests and liver and kidney function tests periodically Should be administered by IV route only

Other Beta-Lactams

Carbapenems
Drug	Dosage	Remarks
Imipenem/cilastatin	≥3 months old, <40 kg: 15 mg/kg IV 6 hourly Max dose: 4 g/day >40 kg: Same as adult dose Max dose: 2 g/day Adult: 1-2 g/day IV divided 6-8 hourly Max dose: 4 g/day	Adverse Reactions GI effects (diarrhea, nausea/vomiting, antibiotic-associated diarrhea/colitis, tongue/tooth discoloration, altered taste); Hypersensitivity reactions (rash, anaphylaxis); CNS effects (mental disturbances, confusion); Other effect (candidal infections) Imipenem/cilastatin: Seizures/convulsions have been reported especially in patients with a history CNS lesions and/or renal dysfunction Special Instructions Use with caution in patients who are allergic to penicillins, cephalosporins or other β-lactams and with renal impairment and CNS disorders (eg epilepsy)
Meropenem	1-2 months old: 20-40 mg/kg IV 8 hourly 3 months-17 years old: 20-40 mg/kg IV 8 hourly Max dose: 2 g/dose Adult: 500 mg-1 g IV 8 hourly
Monobactam
Aztreonam	1 week-<2 years old: 30 mg/kg IM/IV 6-8 hourly 2-12 years old: 30-50 mg/kg IM/IV 6-8 hourly Adult: 1-8 g/day IM/IV divided 6-12 hourly Max dose: 8 g/day

Penicillins

Aminopenicillins with or without Beta-lactamase Inhibitors
Drug	Dosage	Remarks
Amoxicillin (Amoxycillin)	3 months-17 years old: 50-100 mg/kg/day PO divided 8 hourly Max dose: 4 g/day Adult: 250 mg-1 g PO 8 hourly or 500 mg-1 g IM/IV 6-8 hourly Max dose: 6 g/day	Adverse Reactions Hypersensitivity reactions (rash, urticaria, pruritus, anaphylaxis); GI effects (diarrhea, nausea/vomiting); Other effect (candidal infections) Special Instructions Avoid in patients with penicillin allergy Use with caution in patients with renal impairment
Amoxicillin/clavulanic acid (Co-amoxiclav, Amoxicillin/clavulanate)	3 months-17 years old: 50 mg/kg/day PO divided 8 hourly Adult: 1 g PO 12 hourly or 1.2 g IV 6-8 hourly
Ampicillin/sulbactam (Sultamicillin: Pro-drug of Ampicillin/sulbactam the 2 drugs are linked chemically with a double ester)	3 months-17 years old: 100-200 mg/kg/day IM/IV divided 6 hourly Adult: 1.5-12 g/day IM/IV divided 6-12 hourly Max dose: 4 g/day Sulbactam
Antipseudomonal Penicillins with or without Beta-lactamase Inhibitors
Piperacillin	≥1 month old: 200 mg/kg/day IV divided 6-8 hourly Adult: 2 g IV 6-8 hourly or 4 g IV 12 hourly or 2 g IM 8-12 hourly
Piperacillin/tazobactam	≥12 years old: 12-18 g/day (Piperacillin) IV divided 6-8 hourly
Ticarcillin/clavulanic acid (Ticarcillin/clavulanate)	<2 kg: 80 mg/kg IV 12 hourly >2 kg: 80 mg/kg IV 8 hourly Adult: 3.2 g IV 6-8 hourly Max dose: 18 g/day Ticarcillin
Antistaphylococcal Penicillins
Cloxacillin	>20 kg: 250-500 mg PO 6 hourly Adult: 250-500 mg IM 4-6 hourly or 250-500 mg IV bolus 6 hourly or 250-500 mg PO 6 hourly Max dose: 6 g/day
Dicloxacillin	<40 kg: 12.5-25 mg/kg PO 6 hourly >40 kg: Same as adult dose Adult: 125-500 mg PO 6 hourly
Flucloxacillin	<2 years old: 62.5 mg PO/IM 6 hourly or 62.5-250 mg IV infusion 6 hourly 2-10 years old: 125 mg PO/IM 6 hourly or 125-500 mg IV infusion 6 hourly Adult: 250 mg PO/IM 6 hourly or 250 mg-1 g IV infusion 6-8 hourly
Nafcillin	Adult: 2 g IV 4-6 hourly
Oxacillin	1 month-11 months old, <40 kg: 100-200 mg/kg/day IV divided 4-6 hourly ≥40 kg: 100-200 mg/kg/day IV divided 4-6 hourly Max dose: 12 g/day Adult: 2 g IV 4-6 hourly or 1 g PO 12 hourly

Quinolones

Drug	Dosage	Remarks
Ciprofloxacin	400 mg IV 8-12 hourly or 500-750 mg PO 12 hourly x 4-8 weeks	Adverse Reactions GI effects (nausea/vomiting, diarrhea, abdominal pain, dyspepsia); CNS effects (headache, dizziness, sleep disorders, restlessness, drowsiness); Dermatologic effects (rash, pruritus, photosensitivity); Hypersensitivity reactions (rash, Stevens-Johnson syndrome) 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, impaired renal or hepatic function and those with G6PD deficiency
Levofloxacin	750 mg IV 24 hourly or 250-500 mg PO 12-24 hourly
Pefloxacin	400 mg IV 12 hourly or 800 mg PO 24 hourly

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.

Infectious Arthritis Drug Summary

Disease Summary

Disease Algorithm

Disease Background

Initial Assessment

Diagnostics

Differential Diagnosis

Management

Follow Up

Drug Summary

References