Ceftriaxone Amikacin paediatric dose

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ceftriaxone amikacin pediatric dose mg/kg children 2024

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Ceftriaxone - Paediatric Dose

Drug class: 3rd-generation cephalosporin

Dosing (Children ≥ 4 weeks to 18 years) - IV or IM

Indication	Dose	Frequency
General infections / mild-moderate	50 mg/kg/dose	Once daily (q24h)
Severe infections / sepsis	50 mg/kg/dose	Twice daily (q12h)
Bacterial meningitis	100 mg/kg/dose	Once daily (q24h) OR 50 mg/kg q12h
Surgical prophylaxis	50-75 mg/kg/dose	Single pre-op dose
Appendicitis (empirical)	50 mg/kg IV	Once daily
Endocarditis (Strep viridans)	100 mg/kg/day	Once daily
Meningococcal prophylaxis (≥4 wk, <12 yr)	125 mg	Single IM dose
Meningococcal prophylaxis (≥12 yr)	250 mg	Single IM dose
Gonorrhoea prophylaxis/treatment	50 mg/kg (max 500 mg)	Single IM dose

Maximum doses:

Standard: 2 g/dose (or 2 g/day for most indications)
Meningitis: up to 4 g/day
Endocarditis: 100 mg/24h (paediatric dose, not to exceed adult dose)

Neonates

Avoid ceftriaxone in neonates <44 weeks corrected gestational age. Ceftriaxone displaces bilirubin from albumin (risk of kernicterus) and can precipitate with calcium-containing IV fluids. Use cefotaxime instead.

If unavoidable (>44 weeks corrected): 50 mg/kg IV/IM q24h - consult specialist.

Route & Administration

IV: Infuse over 30-60 minutes
IM: Reconstitute with 1% lidocaine to reduce pain (in children old enough)
Do NOT mix with calcium-containing solutions in same line

Renal/Hepatic Adjustment

No dose adjustment needed if GFR ≥10 mL/min/1.73m²
GFR <10: usual dose q24h; max 2 g/day
Combined severe renal + hepatic failure: max 2 g/day

Amikacin - Paediatric Dose

Drug class: Aminoglycoside (inhibits bacterial protein synthesis)

Dosing - Children beyond the newborn period (IV or IM)

Age Group	Dose	Frequency
Infants & Children (standard)	15 mg/kg/day	Divided: 7.5 mg/kg q12h or 5 mg/kg q8h
Once-daily dosing (preferred in most centres)	15-20 mg/kg	Once daily (q24h)
Maximum daily dose	15 mg/kg/day (max 1.5 g/day in heavier patients)	-

Duration: 7-10 days typically

Neonatal Dosing (extended-interval, by gestational/postnatal age)

Postmenstrual Age	Postnatal Age	Dose	Interval
≤29 weeks	0-7 days	14 mg/kg	q48h
≤29 weeks	8-28 days	12 mg/kg	q36h
≤29 weeks	≥29 days	12 mg/kg	q24h
30-34 weeks	0-7 days	12 mg/kg	q36h
30-34 weeks	≥8 days	12 mg/kg	q24h
≥35 weeks	All	12 mg/kg	q24h

Perinatal asphyxia / therapeutic hypothermia: Increase dose interval by 12 hours. Amikacin clearance is reduced ~40% in therapeutic hypothermia. COX inhibitors (indomethacin/ibuprofen): Also increase interval by 12 hours.

Route & Administration

IV infusion: Over 30-60 minutes in children; 20-30 minutes in neonates
IM: Acceptable if IV not available; avoid in very premature (<1.5 kg) without dilution

Therapeutic Drug Monitoring (TDM) - Mandatory for extended courses

Parameter	Target
Peak (30 min post-infusion)	24-35 mg/L (neonates); 20-35 mg/L (children)
Trough (1h pre-dose)	<5 mg/L
Routine TDM <48h	Not required unless renal impairment

For courses >48 hours: Obtain trough + peak levels. If trough ≥5 mg/L - withhold dose and repeat trough before re-dosing.

Key Toxicities (monitor)

Nephrotoxicity - monitor SCr/urine output
Ototoxicity (vestibular + cochlear) - irreversible; perform audiology on prolonged courses
Both toxicities are concentration- and duration-dependent

Renal Impairment

Reduce frequency (not dose) based on serum levels; consult pharmacy/TDM service

Sources: Red Book 2021 (AAP Committee on Infectious Diseases), Rosen's Emergency Medicine, Australasian Neonatal Medicines Formulary 2024, Perth Children's Hospital ChAMP Monograph, Harrison's Principles of Internal Medicine 22e

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