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Pharmacology Restorative Dentistry

Follow-up: Anti-infectives pediatric dosage

This is a follow-up post to the Refresher: Why use anti-infectives?

A number of dentists inquired about the pediatric doses for the anti-infectives mentioned in the post. Sources of information: Lexicomp and e-Therapeutics.ca

Amoxicillin

  • Children ≤3 months: Oral: 20-30 mg/kg/day divided every 12 hours
  • Children >3 months and <40 kg: Oral: 20-100 mg/kg/day in divided doses every 8-12 hours
  • Children >3 months and ≥40 kg: Refer to adult dosing.
  • Children ≥12 years: Oral: Extended-release tablet: 775 mg once daily

Amoxicillin and Clavulanate

  • Susceptible infections: Infants <3 months: Oral: 30 mg/kg/day divided every 12 hours using the 125 mg/5 mL suspension
  • Mild-to-moderate infections: Children ≥3 months and <40 kg: Oral: 25 mg/kg/day divided every 12 hours or 20 mg/kg/day divided every 8 hours
  • Children >40 kg: Refer to adult dosing.

Cephalexin

  • Usual dose: Children >1 year: Oral: Dosing range: 25-100 mg/kg/day in divided doses every 6-8 hours (maximum: 4 g/day)
  • Severe infections: Children: Oral: 50-100 mg/kg/day in divided doses every 6-8 hours

Calrithromycin

Sinusitis, bronchitis, skin infections: Oral: 7.5 mg/kg/dose every 12 hours for 10 days

Clindamycin

Infants and Children:

  • Oral: 8-40 mg/kg/day in 3-4 divided doses; Manufacturer’s labeling: 8-20 mg/kg/day (as hydrochloride) or 8-25 mg/kg/day (as palmitate) in 3-4 divided doses; minimum dose of palmitate: 37.5 mg 3 times daily
  • I.M., I.V.: Manufacturer’s labeling: 20-40 mg/kg/day in 3-4 divided doses

Doxycycline

Usual dosage range:

  • Children >8 years (≤45 kg): Oral, I.V.: 2-5 mg/kg/day in 1-2 divided doses, not to exceed 200 mg/day
  • Children >8 years (>45 kg): Oral, I.V.: Refer to adult dosing.

Erythromycin

Usual dosage range: Infants and Children:

Oral:

  • Base: 30-50 mg/kg/day in 2-4 divided doses; maximum: 2 g daily
  • Ethylsuccinate: 30-50 mg/kg/day in 2-4 divided doses; maximum: 3.2 g daily
  • Stearate: 30-50 mg/kg/day in 2-4 divided doses; maximum: 2 g daily
  • I.V.: Lactobionate: 15-50 mg/kg/day divided every 6 hours, not to exceed 4 g daily
  • Mild/moderate infection: Oral: 30-50 mg/kg/day in divided doses every 6-12 hours

Metronidazole

Children ≥1 month of age: 15–35 mg/kg/day po in 3 divided doses.

Penicillin V Potassium

  • Adults and Children >12 Years: 1-4 g daily in 3 to 4 divided doses.
  • Children <12 Years: 25-100 mg/kg/day in 3 to 4 divided doses, maximum 3 g/day.
  • Treatment of Group A beta-hemolytic streptococcal infections may be dosed every 12 hours for adults and children.

Nystatin Oral Suspension: Oral candidiasis

  • Infants: 200,000 units 4 times/day or 100,000 units to each side of mouth 4 times/day; paint suspension into recesses of the mouth
  • Children: 400,000-600,000 units 4 times/day; swish in the mouth and retain for as long as possible (several minutes) before swallowing

Fluconazole

Usual dosage range: Oral, I.V: Loading dose: 6-12 mg/kg/dose; maintenance: 3-12 mg/kg/dose once daily; duration and dosage depend on location and severity of infection

Itraconazole

Candidiasis:

  • Oropharyngeal: Oral solution: 2.5 mg/kg/dose twice daily (maximum: 200 mg/day [400 mg/day if fluconazole-refractory]) for 7-14 days
  • Esophageal: Oral solution: 5 mg/kg/day once daily or divided twice daily for 4-21 days

Ketoconazole

Fungal infections: Children ≥2 years: Oral: 3.3-6.6 mg/kg once daily

 

Do you have any particular question on this topic? Do you have any comments or suggestions? Email us at oasisdiscussions@cda-adc.ca

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