Aminoglycosides

Drug	Dosage	Remarks
Amikacin	15 mg/kg/day IM/IV divided 8-12 hourly Max dose: 1.5 g/day	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) Special Instructions 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 Ototoxicity and nephrotoxicity are most likely in geriatric, dehydrated patients, those 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 concentrations and/or peak serum concentrations/minimum inhibitory concentration (MIC) ratio in these patients
Dibekacin	1-3 mg/kg/day IM/IV in divided doses or 100 mg/day IM divided 12-24 hourly or 100 mg/day IV infusion divided 12 hourly
Gentamicin	3 mg/kg/day IM/IV divided 8 hourly May increase dose up to 5 mg/kg/day divided 6-8 hourly for severe infection
Isepamicin	15 mg/kg/day IM/IV divided 12 hourly Max dose: 1.5 g/day
Kanamycin	15 mg/kg/day IM/IV divided 12 hourly or 1-2 g/day IM divided 12-24 hourly
Netilmicin	4-6 mg/kg/day IM/IV divided 8-12 hourly May increase dose up to 7.5 mg/kg/day divided 8 hourly for severe infection
Tobramycin	3 mg/kg/day IM/IV divided 8 hourly May increase dose up to 5 mg/kg/day divided 6-8 hourly for severe infection

Cephalosporins

^{First Generation}
Drug	Dosage	Remarks
Cefadroxil	500 mg-1 g PO 12 hourly	Adverse Reactions GI effects (nausea/vomiting, diarrhea); Hypersensitivity effects (urticaria, pruritus, rash, angioedema); CNS effects (dizziness, headache); Other effects (reversible neutropenia, leukopenia, increased serum transaminases, pseudomembranous colitis, monilial vaginitis) Special Instructions May be taken with food to reduce GI distress Use with caution in patients allergic to Penicillin or with renal impairment
Second Generation
Cefaclor	250-500 mg PO 8 hourly or 750 mg PO 12 hourly Max dose: 4 g/day	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), 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 May be taken with food to decrease gastric distress Use with caution in patients allergic to Penicillin or with renal impairment
Cefamandole	500 mg IV 6 hourly
Cefminox	1 g IV 12 hourly
Cefotiam	200-400 mg PO 12 hourly or 6 g/day IM/IV in divided doses (as hydrochloride) or 200-400 mg IM/IV 12 hourly (as hexetil hydrochloride)
Cefoxitin	1-2 g IM/IV 6-8 hourly Max dose: 12 g/day
Cefprozil	500 mg PO 12 hourly
Cefuroxime	750 mg-1.5 g IM/IV 8 hourly or 500 mg PO 12 hourly Max dose: 6 g/day
Third and Fourth Generation
Cefdinir	300 mg PO 12 hourly
Cefditoren	400 mg PO 12 hourly
Cefepime	1-2 g IM/IV 12 hourly or 2 g IV 8 hourly Max dose: 6 g/day
Cefetamet	500 mg PO 12 hourly
Cefixime	200-400 mg PO 24 hourly or divided 12 hourly
Cefoperazone	1-2 g IM/IV 12 hourly
Cefotaxime	1 g IM/IV 12 hourly Max dose: 12 g/day
Cefpirome	1-2 g IV 12 hourly
Cefpodoxime	100-200 mg PO 12 hourly
Ceftazidime	500 mg-1 g IM/IV 8 hourly
Ceftibuten	400 mg PO 24 hourly
Ceftizoxime	1-2 g IM/IV 8-12 hourly
Ceftriaxone	1-2 g IM/IV 24 hourly
Latamoxef	2 g/day IM/IV divided 12 hourly
Fifth Generation
Ceftaroline fosamil	600 mg IV 12 hourly
Ceftobiprole	500 mg IV 8 hourly
Cephalosporins with Beta-lactamase Inhibitors
Cefepime/tazobactam	1-2 g/day IM/IV 12 hourly x 10 days
Cefoperazone/sulbactam	2-4 g/day IM/IV divided 12 hourly (1:1 ratio)

Macrolides

Drug	Dosage	Remarks
Dirithromycin	500 mg PO 24 hourly	Adverse Reactions GI effects (nausea/vomiting, abdominal discomfort, diarrhea and other GI disturbances, antibiotic-associated diarrhea/colitis); Other effect (candidal infections) Hypersensitivity effects (urticaria, pruritus, rash, rarely anaphylaxis) are uncommon; Dose-related tinnitus/hearing loss has occurred with some macrolides; Rarely cardiotoxicity and hepatotoxicity Special Instructions May take with food to decrease gastric distress Physician should be informed if the patient vomits within 5-60 minutes after taking the dose Use with caution in patients with hepatic dysfunction or cardiac dysfunction (especially with long QTc interval)
Erythromycin	250 PO 6 hourly or 400 mg PO 6 hourly or 500 mg PO 12 hourly or 15-20 mg/kg/day divided 6 hourly Max dose: 4 g/day
Josamycin	1-2 g/day PO divided 12 hourly
Midecamycin	900 mg-1.8 g divided 8-12 hourly
Roxithromycin	150 mg PO 12 hourly or 300 mg PO 24 hourly
Spiramycin	1.5-3 MIU IV 8 hourly or 6-9 MIU PO divided 8-12 hourly or 500 mg PO 8 hourly
Advanced Macrolides
Azithromycin	500 mg PO 24 hourly on day 1 followed by 250 mg PO 24 hourly on days 2-5 or 500 mg PO 24 hourly x 3 days Extended-release: 2 g PO as single dose or 500 mg IV 24 hourly	Adverse Reactions GI effects (nausea/vomiting, abdominal discomfort, diarrhea, other GI disturbances, antibiotic-associated diarrhea/colitis); Other effect (candidal infections) Hypersensitivity effects (urticaria, pruritus, rash, rarely anaphylaxis) are uncommon; Dose-related tinnitus/hearing loss has occurred with some macrolides; Rarely cardiotoxicity, hepatotoxicity Azithromycin and Clarithromycin tend to cause less GI disturbances than Erythromycin Special Instructions May take with food to decrease gastric distress Azithromycin extended-release should be taken on an empty stomach at least 1 hour before or 2 hours after a meal Physician should be informed if the patient vomits within 5-60 minutes after taking the dose Use with caution in patients with hepatic dysfunction or cardiac dysfunction (especially with long QTc interval)
Clarithromycin	250-500 mg PO 12 hourly Extended-release: 1,000 mg PO 24 hourly or 500 mg IV 12 hourly

Other Antibiotics

Fusidate
Drug	Dosage	Remarks
Fusidic acid (Na fusidate, Sodium fusidate)	500 mg PO 8 hourly Oral suspension: 750 mg PO 8 hourly	Adverse Reactions GI effect (mild GI upset, nausea/vomiting, epigastric pain, dyspepsia, anorexia); Hepatic effects (jaundice and reversible changes in liver function) Special Instructions Use with caution in patients with liver dysfunction and monitoring of hepatic function in these patients is recommended if on high or prolonged doses
Glycopeptides
Teicoplanin	6 mg/kg IV/IM 12 hourly x 3 doses followed by 6 mg/kg IV/IM 24 hourly	Adverse Reactions Hypersensitivity effects (fever, chills, skin rash, pruritus, occasionally anaphylaxis, bronchospasm, Stevens-Johnson syndrome [SJS]); GI effect (GI disturbances); CNS effects (dizziness, headache); Hematologic effects (eosinophilia, leukopenia); Hepatic effects 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 LFTs are advised
Vancomycin	1 g IV 12 hourly or 500 mg IV 6 hourly or Loading dose: 20-35 mg/kg IV Maintenance dose: 15-20 mg/kg/dose IV 8-12 hourly Adjust subsequent dose based on AUC-guided or trough-guided serum concentration monitoring	Adverse Reactions Hypersensitivity effects (anaphylactoid reactions, SJS, red neck syndrome [related to very rapid infusion], flushing, erythema, rash over face and upper torso, hypotension and shock-like symptoms); Hematologic effects (reversible neutropenia, eosinophilia); Renal effect (nephrotoxicity 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 Use with caution in patients with impaired hearing or previous hearing loss, impaired renal function and the elderly Monitoring of CBC and renal function during treatment is suggested along with monitoring of auditory function
Lincosamide
Clindamycin	600 mg-1.8 g/day PO divided 6-12 hourly or 1.2-2.7 g/day IM/IV divided 6-12 hourly Max dose: 4.8 g/day	Adverse Reactions GI effects (diarrhea, severe antibiotic-related pseudomembranous colitis, nausea/vomiting, abdominal pain, metallic taste); Hypersensitivity effects (rash, urticaria, rarely anaphylaxis); Dermatologic effects (erythema multiforme, exfoliative and vesiculobullous dermatitis); Other effect (polyarthritis); Hematologic and hepatic effects have occurred Special Instructions Use with caution in patients with GI disease especially those with a history of colitis, atopic disease or hepatic impairment Discontinue if diarrhea occurs
Nitroimidazole Derivative
Metronidazole	500 mg PO/IV 8-12 hourly or 7.5 mg/kg PO/IV 6 hourly Max dose: 4 g/day	Adverse Reactions GI effects (nausea/vomiting, metallic taste, diarrhea, constipation); CNS effects have been reported (weakness, dizziness, headache, mood changes, peripheral neuropathy has occurred at high/prolonged doses); Other effects (candidal infection, may cause darkening of urine); Hematologic and hepatic effects have occurred; Rarely hypersensitivity reactions High dose or prolonged use has caused peripheral neuropathy and epileptiform seizures Special Instructions When given with alcohol, a disulfiram-like reaction can occur Use with caution in patients with severe hepatic impairment If given >10 days recommend monitoring CBCs and clinical monitoring for CNS effects
Oxazolidinone
Linezolid	600 mg PO/IV 12 hourly x 10-14 days	Adverse Reactions GI effects (diarrhea, nausea/vomiting, metallic taste, constipation, antibiotic-associated diarrhea/colitis); CNS effects (headache, insomnia, dizziness); Hepatic effect (abnormal LFTs); Hematologic effects (reversible myelosuppression including leukopenia, anemia, pancytopenia, thrombocytopenia); Other effect (moniliasis infection) Special Instructions Use with caution in patients with pre-existing myelosuppression and in patients with severe renal dysfunction Recommend CBC monitoring weekly
Pleuromutilin
Lefamulin	600 mg PO 12 hourly x 5 days or 150 mg IV infusion over 60 minutes 12 hourly May be switched to PO for total duration of treatment of 7 days	Adverse Reactions Injection: CNS effects (insomnia, headache); Other effects (injection site reaction, increased LFTs, nausea, hypokalemia) PO: GI effects (nausea/vomiting, diarrhea); Other effect (increased LFTs) Special Instructions Avoid use in patients with moderate to severe hepatic impairment Use with caution in patients with known QT prolongation, ventricular arrhythmias including torsades de pointes and those receiving antiarrhythmic agents and those at risk for Clostridioides difficile-associated diarrhea Advise females of reproductive potential to use effective contraception due to possible embryo-fetal toxicity
Polymyxin
Colistimethate Na	2.5-5 mg/kg/day IM/IV divided 6-12 hourly Max dose: 5 mg/kg/day	Adverse Reactions CNS effects (dizziness, vertigo, slurred speech); Renal effects (nephrotoxicity, proteinuria); Other effects (GI upset, paresthesias, weakness of lower limbs, injection site irritation) Respiratory arrest has been reported Special Instructions Use with caution in patients with pre-existing renal disease and myasthenia gravis

Other Beta-Lactams

Carbapenems
Drug	Dosage	Remarks
Biapenem	1.2 g/day IV infusion over 30-60 minutes divided 12 hourly Max dose: 1.2 g/day	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); Other effect (candidal infections); Rarely severe dermatologic (exfoliative dermatitis, SJS) and hepatic effects Imipenem/cilastatin: Seizures and convulsions have been reported especially in patients with history of CNS lesions and/or renal dysfunction) Special Instructions Use with caution in patients allergic to penicillins, cephalosporins or other beta-lactams, patients with renal impairment or CNS disorders (eg epilepsy)
Ertapenem	1 g IM/IV 24 hourly
Imipenem/cilastatin	500 mg IV 6 hourly
Meropenem	500 mg-1 g IV 8 hourly
Monobactam
Aztreonam	1-2 g IM/IV 8-12 hourly *Severe or P aeruginosa* infection: 2 g IV 6-8 hourly Max dose:** 8 g/day	Adverse Reactions Hypersensitivity effects (rash, urticaria, pruritus, anaphylaxis); GI effects (diarrhea, nausea/vomiting, antibiotic-associated diarrhea/colitis); Other effect (candidal infections); Renal and hepatic effects have occurred; Rarely hematologic effects Special Instructions Use with caution in patients allergic to penicillins, cephalosporins or other beta-lactams and in patients with renal impairment

Penicillins

Drug	Dosage	Remarks
Benzylpenicillin (Penicillin G, Penicillin G Na, Penicillin G K)	5-24 MU/day IM/IV divided 4-6 hourly	Adverse Reactions Hypersensitivity effects (rash, urticaria, pruritus, anaphylaxis); 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
Aminopenicillins with or without Beta-lactamase Inhibitors
Amoxicillin	250 mg-1 g PO 8 hourly or 70 mg-2 g IM/IV 8 hourly or 2 g IM/IV 8 hourly
Amoxicillin/clavulanic acid (Co-amoxiclav, Amoxicillin/clavulanate)	625 mg PO 8 hourly or 1 g PO 12 hourly Extended release: 2,000 mg/125 mg PO 12 hourly or 1.2 g IV 6-8 hourly
Ampicillin	250 mg-1 g PO 6 hourly or 500 mg IM/IV 4-6 hourly
Ampicillin/sulbactam (Sultamicillin: Pro-drug of Ampicillin/sulbactam)	375-750 mg PO 12 hourly or 1.5-3 g IM/IV 6 hourly or 1.5-12 g IM/IV in divided doses Max dose: 12 g/day IM/IV
Sultamicillin tosylate (Sultamicillin tosilate)	375-750 mg PO 12 hourly
Antipseudomonal Penicillins with or without Beta-lactamase Inhibitor
Piperacillin	3-4 g IM/IV 4-6 hourly Max dose: 24 g/day
Piperacillin/tazobactam	2.25-4.5 g slow IV 6-8 hourly or 3.375 g IV 6 hourly
Ticarcillin/clavulanic acid (Ticarcillin/clavulanate)	3.2 g IV 6-8 hourly
Antistaphylococcal Penicillins
Cloxacillin	250-500 mg PO 6 hourly or 250-500 mg IM/IV 4-6 hourly
Dicloxacillin	500 mg PO 6 hourly
Flucloxacillin	250-500 mg PO 6 hourly
Oxacillin	1 g PO 12 hrly or 250 mg-1 g IM/IV 4-6 hourly

Quinolones

Drug	Dosage	Remarks
Ciprofloxacin	500-750 mg PO 12 hourly or 400 mg IV 8-12 hourly	Adverse Reactions GI effects (nausea/vomiting, diarrhea, abdominal pain, dyspepsia, flatulence, gastritis, anorexia, rarely antibiotic-associated diarrhea/colitis); Hepatic effects (increased LFTs, bilirubinemia, GGT and γ-GTP); CNS effects (headache, dizziness, sleep disorders, restlessness, drowsiness, tremor, anxiety, depression, nightmares, insomnia or suicidal thoughts); Dermatologic effects (rash, pruritus, photosensitivity); Hypersensitivity effects (rash, SJS, anaphylactic shock); GU effects (vaginitis, genital pruritus, fungal infection on reproductive organs); Rarely hematologic, hepatic and renal effects Some quinolones may 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 Maintain adequate fluid intake 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, G6PD deficiency, history of QTc prolongation, uncorrected electrolyte disorders (eg hypokalemia or hypomagnesemia), and those receiving class IA or class III antiarrhythmic agents Discontinue if SJS, epidermal necrolysis or erythema multiforme occurs
Gemifloxacin mesylate	320 mg PO 24 hourly x 5-7 days
Levofloxacin	500 mg PO 24 hourly or 500-750 mg IV 12-24 hourly
Moxifloxacin	400 mg PO 24 hourly or 400 mg IV infusion over 60 minutes 24 hourly
Ofloxacin	400 mg PO 12 hourly or 200-400 mg IV infusion over 30 minutes 12 hourly
Prulifloxacin	200-300 mg PO 12 hourly
Sitafloxacin hydrate	50 mg PO 12 hourly or 100 mg PO 24 hourly
Sparfloxacin	100-300 mg/day PO divided 12-24 hourly

Tetracyclines

Drug	Dosage	Remarks
Doxycycline	100 mg PO 12 hourly or 200 mg PO 24 hourly on day 1 followed by 50 mg PO 12 hourly or 100 mg PO 24 hourly or 200 mg IV 24 hourly x 1 day then 100 mg IV 24 hourly or 100 mg IV 12 hourly	Adverse Reactions Dermatologic effect (photosensitivity); GI effects (nausea/vomiting, diarrhea, antibiotic-associated diarrhea/colitis, dysphagia, esophageal ulceration may occur when taken with an insufficient amount of liquid); Other effects (candidal infections, discoloration of teeth, interference with bone growth in young infants/pregnant women); Hypersensitivity effects have occurred Rarely renal dysfunction, hepatotoxicity, hematologic effects, increased intracranial pressure with headache and visual disturbances Special Instructions Avoid long exposure to sunlight or tanning beds Take with plenty of fluid while sitting or standing and before retiring to bed Avoid in pregnant women; avoid in patients with systemic lupus erythematosus (SLE) Use with caution in patient with renal or hepatic impairment
Minocycline	100-200 mg PO on day 1 followed by 100 mg PO 12 hourly or 50 mg PO 6-12 hourly x 1 day then 50 mg PO 6 hourly	Adverse Reactions CNS effects (headaches, lightheadedness, dizziness, vertigo, increased intracranial pressure); GI effects (nausea/vomiting, anorexia, diarrhea, stomatitis, glossitis, dysphagia); Other effects (dental staining, maculopapular and erythematous rashes, hypersensitivity reactions) Special Instructions Administer with plenty of fluid to reduce risk of esophageal irritation and ulceration Avoid long exposure to sunlight/UV light Avoid concomitant administration of Isotretinoin or other systemic retinoids and Al-, Ca- or Mg-containing antacids Use with caution in patients with SLE, hepatic dysfunction, renal impairment, on anticoagulant therapy
Omadacycline	Initial dose: 200 mg IV infusion over 60 minutes or 100 mg IV infusion over 30 minutes 12 hourly on day 1 Maintenance dose: 100 mg IV infusion over 30 minutes 24 hourly or 300 mg PO 24 hourly	Adverse Reactions GI effects (nausea/vomiting, diarrhea, constipation); Hepatic effects (increased LFTs, GGT); CNS effects (headache, insomnia); Other effects (infusion site reactions, hypertension, discoloration of teeth, interference with bone growth in pregnant women) Special Instructions Avoid in pregnant women
Tigecycline	100 mg IV followed by 50 mg 12 hourly by IV infusion over approximately 30-60 minutes	Adverse Reactions GI effects (abdominal pain, diarrhea, dyspepsia, nausea/vomiting); CNS effects (headache, dizziness, asthenia); Other effects (infection, phlebitis, pneumonia, rash, abnormal healing, anemia, hyponatremia, hypoproteinemia, prolonged aPTT and PT, bilirubinemia, increased LFTs and serum amylase) Special Instructions Avoid in patients with diabetic foot infections, hospital-acquired or ventilator-associated pneumonia Use with caution in patients with severe hepatic impairment, acute pancreatitis, C difficile-associated diarrhea Institute appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment and surgical evaluation Close monitoring for the development of superinfection

Vaccines

Drug	Dosage	Remarks
Vaccine, influenza, inactivated virus^1,2 (Influenza virus strains type A and B determined annually by WHO according to surveillance data) Trivalent influenza vaccine: 2 type A and 1 type B strains Quadrivalent influenza vaccine: 2 type A and 2 type B strains High-dose trivalent or quadrivalent influenza vaccine	0.5 mL IM/deep SC to be given annually Dose and route (IM or deep SC administration) will depend on formulation Please verify dosing with package information	Adverse Reactions Local effect (injection site soreness); CNS effect (headache); Other effects (GI disturbances, oculorespiratory syndrome, fever, malaise) Special Instructions High-dose influenza vaccine is indicated for use in persons ≥65 years old Contraindicated in individuals with severe allergic reaction to any component of the vaccine Use with caution in patients with moderate to severe acute illness and with history of Guillain-Barré syndrome (GBS)
Vaccine, influenza, purified antigen (Live, attenuated influenza vaccine [LAIV])¹ (Influenza virus strains type A and B determined annually by WHO according to surveillance data)	Only indicated for healthy individuals: 0.1 mL in each nostril as a single dose	Adverse Reactions Respiratory effects (runny nose, congestion, sore throat, cough); CNS effects (headache, fever) Special Instructions Do not administer parenterally Contraindicated in individuals with severe allergic reaction to any component of the vaccine, pregnant patients, or with severe immunodeficiency Avoid use of antivirals 48 hours before and 14 days after vaccination Use with caution in patients with moderate to severe acute illness, with history of GBS and close contact with an immunosuppressed individual
Vaccine, influenza, recombinant virus (Influenza virus strains type A and B determined annually by WHO according to surveillance data) Trivalent influenza vaccine: 2 type A and 1 type B strains Quadrivalent influenza vaccine: 2 type A and 2 type B strains	0.5 mL IM to be given annually	Adverse Reactions Local effect (injection site soreness, pain); CNS effect (headache); Other effects (myalgia, fatigue, fever) Special Instructions Contraindicated in individuals with severe allergic reaction to any component of the vaccine Postpone vaccination in patents with acute febrile illness Use with caution in patients with thrombocytopenia or bleeding disorder
Vaccine, influenza, surface antigen, inactivated, adjuvanted with MF59C.1 (Adjuvant vaccine)	Elderly ≥65 years old: 0.5 mL IM single dose into the deltoid muscle	Adverse Reactions Local injection site reactions (redness, swelling, pain, ecchymosis and induration); Other effects (fever, malaise, shivering, headache, sweating, myalgia, arthralgia) Special Instructions Not to be administered intravascularly Contraindicated in patients with allergies to aminoglycosides, formaldehyde, cetyltrimethylammonium bromide and polysorbate 80 Postpone immunization in febrile illness or acute infection
Vaccine, pneumococcal (Pneumococcal conjugate vaccine, 13-valent [PCV13])	0.5 mL IM as a single dose	Adverse Reactions Local effects (injection site erythema, swelling, pain); CNS effects (irritability, somnolence, headache); Other effects (fever, vomiting, decreased or increased sleep, rash, decreased appetite, diarrhea, muscle and joint pain) Special Instructions Contraindicated in patients with fever, acute disease, anaphylactic reaction to a previous dose or allergy to any component of the vaccine Use with caution in patients with coagulation disorders or on anticoagulation therapy
Vaccine, pneumococcal (Pneumococcal conjugate vaccine, 15-valent [PCV15]	0.5 mL IM as a single dose	Adverse Reactions Local effects (injection site erythema, swelling, pain); Other effects (headache, fatigue, myalgia, arthralgia) Special Instructions Contraindicated in patients with fever, acute disease, anaphylactic reaction to a previous dose or allergy to any component of the vaccine Use with caution in patients with coagulation disorders or on anticoagulation therapy
Vaccine, pneumococcal (Pneumococcal conjugate vaccine, 20-valent [PCV20])	0.5 mL IM as a single dose	Adverse Reactions Local effects (injection site erythema, swelling, pain); Musculoskeletal effects (muscle pain, arthralgia); Other effects (fatigue, headache) Special Instructions Contraindicated in patients with anaphylactic reaction to a previous dose or allergy to any component of the vaccine or diphtheria toxoid Use with caution in patients with altered immunocompetence
Vaccine, pneumococcal (Pneumococcal conjugate vaccine, 21-valent [PCV21])	0.5 mL IM as a single dose	Adverse Reactions Local effects (injection site erythema, swelling, pain); Musculoskeletal effects (muscle pain, arthralgia); Other effects (fatigue, headache) Special Instructions Contraindicated in patients with anaphylactic reaction or allergy to any component of the vaccine or diphtheria toxoid Use with caution in patients with altered immunocompetence
Vaccine, pneumococcal (Pneumococcal polysaccharide vaccine, 23-valent [PPSV23])	0.5 mL IM/SC as a single dose if unvaccinated or vaccination history is unknown	Adverse Reactions Local effects (injection site erythema, swelling, pain); CNS effects (fever, headache, malaise) Special Instructions Re-vaccinate ≥5 years after first dose to people ≥65 years old if the first dose was given prior to 65 years of age or if at risk of fatal pneumococcal infection Contraindicated in patients with fever, acute disease, anaphylactic reaction to a previous dose, severe primary immunodeficiency Use with caution in patients with severe renal, hepatic, cardiac, vascular and/or pulmonary dysfunction Efficacy may be reduced in patients with multiple myeloma, Hodgkin’s and non-Hodgkin’s lymphoma, especially during treatment Should be given 2 weeks before or at least 3 months after immunosuppressive treatment
Vaccine, respiratory syncytial virus (RSV, RSV vaccine)	0.5 mL IM as a single dose	Adverse Reactions Local effects (injection site erythema, swelling, pain); CNS effect (headache); Other effects (myalgia, arthralgia, fever, chills) Special Instructions Postpone vaccination in patients with acute febrile illness Use with caution in patients with thrombocytopenia or any other coagulation disorder

¹Influenza vaccine is also available in combination with diphtheria, tetanus, pertussis, hepatitis B and/or polio vaccines. Please see the latest MIMS for specific formulations and prescribing information.
²Various preparations of inactivated influenza vaccines (eg inactivated split virion, inactivated surface antigen, whole-virion, and virosomal adjuvanted) are available. Please see the latest MIMS for specific formulations and prescribing information.

Disclaimer

All dosage recommendations are for 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.

Pneumonia - Community-Acquired Drug Summary