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Indian Antibiotic Guideline For Dosage Guide For Commonly Used Antimicrobial Agents

Indian Antibiotic Guideline For Dosage Guide For Commonly Used Antimicrobial Agents

In 2016 National Centre For Disease Control, Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India came out with National Treatment Guidelines for Antimicrobial Use in Infectious Diseases.

Following are its major recommendations for dosage for  For Commonly Used Antimicrobial Agents

ANTIBIOTICS ADVERSE REACTION ROUTE PAEDIATRIC DOSE ADULT DOSE
Amikacin Nephrotoxicity, Ototoxicity Intravenous 15-22.5 mg/Kg/day

in 2-3 doses

15mg/Kg/day q 8-12

hours, max doses

1.5mg/Kg

Amoxycillin Fever, rash, diarrhea, abdominal cramps, AST ALT elevation Oral 20-50mg/Kg/day, 3-4

doses

250-500mg q 8 hourly
Amoxycillinclavunate

(co-amoxyclav)

Rash, diarrhea, abdominal, AST ALT elevation Oral,

 

Intravenous

40mg/kg/day

(amoxicillin) in 2

doses

90mg/kg/day if

penicillin resistant S.

pneumoniaesuspected

in otitis media

100mg/kg/day

375mg 8hourly

625-1000mg 12 hourly

Ampicillin Hypersensitivity reaction, nausea, diarrhea, exfoliative dermatitis, seizures, precipitates infectious mononucleosis rash, interstitial nephritis. Intravenous

or

Oral

100-400 mg/kg/day

in 4 doses (IV)

500 mg-1gm q 6 hourly
Azithromycin Leukopenia, transient elevation of liver enzymes, renal toxicity. Oral 10 mg/kg/day once

daily

Enteric fever 20

mg/kg/day once daily

500mg daily
Azetronam Rash, Diarrhoea , vomiting, AST, ALT elevation Intravenous 30 – 120mg/kg/day

Q 6-8 hourly

In cystic fibrosis max

dose 200 mg/kg/day

1-2g q 8 hourly, Max

dose 8gm in 24 hours

Benzathine

penicillin

Hypersensitivity and Jarisch Herxheimer reaction, haemolytic anemia, seizures with high doses in renal failure Intramuscular 1,200,000 units( >30

Kg)

600,000 units ( <30

Kg)

1.2-2.4 million

units/dose

Cefadroxil Rash eosinophilla Oral 30 mg/kg/day in 2

doses

500mg bid or 1 g bid
Cefazolin Leukopenia, eosinophilia, rash, transient elevation of liver enzymes renal toxicity Intravenous 100 mg/kg/day 3-4 divided doses 0.52gm q 6-8 hourly
Cefepime Same as third generation cephalosporins. Adjust dose in renal failure Intravenous 1-4gm/day 2-3 doses
Cefixime Diarrhoea, Leukopenia, renal toxicity, transient elevation of liver enzymes. Oral 15mg/kg/day in 2

divided doses,

20mg/kg/day in 2

divided doses for

enteric fever

400mg/day in 1-2

divided doses.

Cefotaxime Arrythmia, transient elevation of liver enzymes, renal toxicity. Intravenous 100mg/kg/day in 3-4

divided doses,

200mg/kg/day in 4

divided doses for

meningitis

1-2gm 6-8 hourly
Ceftazidime Hypersensitivity reaction, dizziness, rash, diarrhea, colitis, exfoliative dermatitis, thrombocytopenia Intravenous

Intramuscular

75-100mg/kg/day in 3 divided doses 100mg/kg/day in meningitis (IV) 1-2g q 8-12 hourly (IV)
Ceftriaxone Gall bladder sludging , transient elevation of liver enzymes, renal toxicity Intravenous 50-100 mg/kg/day in 2 divided doses Meningitis 100mg/kg/day in 2 divided doses 1-2gm q 12-24 hourly
 

Cefuroxime

Leukopenia, eosinophilia, allergic reaction, transient elevation of liver enzymes , renal toxicity Intravenous 75-100mg/kg/day in 3 divided doses 750mg- 1.5g q 8 hourly

 

ANTIBIOTICS ADVERSE REACTION ROUTE PAEDIATRIC DOSE ADULT DOSE
Cefuroxime Leukopenia, eosinophilia, allergic reaction, transient elevation of liver enzymes , renal toxicity Oral 20-30mg/kg/day in 2 divided doses 250-500md bid
Cephalexin Transient neutropenia, AST and ALT elevation, arthralgia, rash, eosinophilia Oral 30-40mg/kg/day in 3

divided doses

250-500mg q 8 hourly
Chloramphenicol Bone marrow suppression, aplastic anaemia, grey baby syndrome, hemolysis in G6PD deficiency Oral

Intravenous

75-100mg/kg/day in 4 divided doses Avoid in infants less than 3 months 50mg/kg/day in 4

divided doses

Ciprofloxacin Nausea, vomiting, abdominal discomfort, arthralgia, photosensitivity transient elevation of liver enzymes Oral

Intravenous

20-30mg/kg/day in 2

divided doses

250-750mg q 12 hourly
Clarithromycin Transient elevation of liver enzymes, renal toxicity, nausea, abdominal cramps Intravenous

Oral

15mg/kg/day in 2

divided doses

250-500mg bid
Clindamycin Diarrhea, nausea, pseudomembranous colitis, skin rash, Erythema multiforme , raised ALT AST, thrombocytopenia, leucopenia Oral

Intravenous

40-60mg/kg/day in 3-

4 divided doses

150-300 mg q 6-8 hourly (oral, iv) Severe infections 300- 600 mg 8 hourly IV
Cloxacillin Dose related neutropenia, elevated AST, ALT, Cholecystitis interstitial nephritis Oral

Intravenous

50-100mg/kg/day in 3-4 divided doses. 100-200mg/kg/day divides q 6 hourly 250-500mg/kg/day in 3-4 divided doses 1-2 gram q 6 hourly
Cotrimoxazole Megaloblastic anaemia, distrurbance, rash, erythema mutliforme major/minor Oral 5-10mg/kg/day in 2 divided doses (5-0 mg trimethoprim) 20mg/kg/day in 4 divided doses in Pneumocystis jirovecii pneumonia 160mg (Trimethoprim) bid
Ertapenem Diarrhoea, nausea, vomiting, headache, hallucination, seizures, arrhythmia, pseudomembranous colitis, dose reduction in renal failure Intravenous

Intramuscular

3-12 years: 15mg/kg/day twice daily. (not to exceed 1gm/day) 13 years and above 1gm IV infusion/ IM once daily in 3-5 ml of lidocain CI if hypersensitivity to lidocaine/β lactam
Erythromycin Arrhythmia Jaundice Oral 40on 4 divided doses 250-500mg q 6 hourly
Furazolidine Avoid alcohol, tyramine containing food, Mao inhibitors, Nausea headache, dizziness, fall in BP, urticarial, safety in pregnancy unknown Oral 100mg 3-4 times a day 5mg/kg in 3-4 divides doses (not below one year) 100mg 3-4 times a day
Gentamicin Nephrotoxicity ototoxicity and optic neuritis Intravenous

Intramuscula

5-7.5 mg/kg/day in 2- 3 divided doses 1.3-6 mg/kg/day in 3 divided doses
Imipenemcilastin Nausea, diarrhea, rash Oral Intravenous 500mg once daily
Linezolid Peripheral and optic neuropathy, thrombocytopenia, hypertension, myelosuppression, colitis Oral

Intravenous

10mg/kg/dose 6-8 hourly (oral, IV) 400-600 mg q 12 hourly
Meropenem Hypotension, transient elevation of liver enzymes, renal modification in renal failure Intravenous Oral 7.5 mg/kg/day/dose (IV) divided doses in meningitis 1.5-3gm/day in 3 divided doses 6gm/day in meningitis
Metronidazole Nausea, metallic taste, disulfuran like reaction with alcohol, peripheral neuropathy Intravenous

Oral

7.5 mg/kg/day dose 3 times/day 30-50mg/kg/day in 3 divided doses for liver abscess 500-700 q 8 hourly
 

Nalidixic acid

Hepatotoxicity, myalgia, leukopenia, vertigo, rash, dizziness, pseudotumor cerebri, seizure, avoid in G6PD deficiency Oral 8 mg/kg/day in 2 divided doses 1gm 4 times/day

 

ANTIBIOTICS ADVERSE REACTION ROUTE PAEDIATRIC DOSE ADULT DOSE
Nitofurantoin Discoloration of urine, vertigo, rash, methemoglobinemia, cholestatic jaundice, hepatocellular damage and neuropathy. Avoid at term and labour  

 

 

Oral

8 mg/kg/day in 2 divided doses 50-100 mg q 6 hourly (5-7mg/kg/day in 4 divided doses max dose 400mg)
Norfloxacin Sam as quinolones Oral 20-30 mg/kg/day in 2 divided doses 200-400 mg twice daily
Ofloxacin Leukopenia, transient of liver enzymes, renal toxicity. May precipitate psychosis/seizures,photosensitivity Oral

Intravenous

20 mg/kg/day in 2 divided doses 200-400 q 12 hourly
Penicillin G Hypersensitivity reaction like anaphylaxis rare. nonfatal reactions are like serum sickness, rash contact dermatitis seen in 1 in 1000 adults. Jarisch Herxheimer reaction, haemolytic anaemia with high doses Oral

Intravenous

50,000units/kg/

dose 6 hourly (Oral)

 

200,000-400,000

units/kg/day in 4

divided doses (IV)

2-24 million units day in divided doses q 4-6 hours (IV)
Penicillin V Rash, haemolytic anaemia interstitial nephritis, seizure with high doses Oral 20-50 mg/kg/day in 4 divided doses 250-500 mg every 6-8 hourly
Piperacillin – Tazobactum Leukopenia, transient elevation of liver enzymes, renal toxicity. Intravenous 200-400mg/kg/day in 3-4 divided doses 4.5 gm q 8hourly
Teicoplanin Hypersensitivity reactions, rash, less nephrotoxic as compares to Vancomycin Intravenous

 

Intramuscular

10mg/kg/day /dose every 12 hours for 3 doses the 10mg/kg/day once daily 400mg once daily (6- 30mg/kg/day)
Tigecycline Nausea, vomiting, allergic reactions, photosensitivity, pseudo tumor cerebri, pancreatitis.

No dose adjustment to renal failure

Intravenous Above 10 years 100mg followed by 50mg every 12 hurly infusion over 30-60 minutes.
Vancomycin

 

Red man syndrome, oto-toxicity, nephrotoxicity Intravenous 40-60 mg/kg/day in 3-4 divided doses 0.5gm q 6 hourly or 1gm q 12 hourly

Drug doses in Pediatric Age group

Drug name Dose Frequency Maximum dose Comments
Cefepime

Infants >14 days of age and Children >40 kg in weight

 

50 mg/kg q 12 h
Ceftazidime

Infants and children <12 years

100–15 mg/kg/d Divided q 8 h 6 g
Cefotaxime

Infants and children

a) < 50 kg

b) >12 years and >50 kg

100–200 mg/kg/d 1–2 g Divided q6-8 h q 8 h 2 g
Ceftriaxone

Infants and children

50-75 mg/kg/d Divided q 12 h 2 g
Vancomycin

Infants and children

40 mg/kg/d Divided q 6-8 h 2 g
Linezolid

Infants and children <12 years

Children >12 years of age and adolescents

10 mg/kg

10 mg/kg

q 8 h

q 12 h

Piperacillin 100-300 mg/kg/d q 8 h 4 g
Ciprofloxacin 20–30 mg/kg/d divided every 12 h 800 mg
Levofloxacin

Children 6 months to 5 years of age

Children >5 years of age

10 mg/kg 10 mg/kg q12 h

q 24 h

500 mg
Amikacin Infants and children 15–22.5

mg/kg/d

q 24 h
Gentamicin 5-7.5 mg/kg/d q q 24 h If normal renal function
Meropenem

Infants ≥3 months of age and children

20 mg/kg q 8 h 1 g
Imepenem-cilastin

Infants < 3 months of age

Infants > 3 months of age and children

100 mg/kg/d

60-100

mg/kg/d

Divided q 6 h

Divided q 6 h

4 g
Fluconazole 12 mg/kg/d q 24 h
Anidulafungin

Children 2– 17 years of age

1.5 mg/kg/day Limited experience
Micafungin

Children >2 years of age

1–4 mg/kg/day 150 mg Limited experience
Caspofungin

Children 3months-17 years

loading dose of 70 mg/m2/day on day 1 followed by 50 mg/m2/day thereafter 70 mg; may increase to 70 mg/m2/day if clinical response is inadequate
Clindamycin 10 mg/kg/dose q 6-8 h  

900 mg Q 8

 

 

 

Source: self

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