Working drug dose in paediatrics

Working doses in paediatrics- Dr. Tarek Rahman

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                   DRUGS                       DOSE                      INTERVAL
Inj Ampicillin(Pen-A:250mg/2.5cc,500mg/5cc)    50mg/kg/dose,      =0.5cc/kg/dose=50unit/kg/dose PNA0-7days:12hrly >7 days:8hrly 
In meningitis:75-150mg/kg/dose
Inj Gentamicin(Genacin,gentin:20,80mg/2cc)  5mg/kg/dose,         =0.5cc/kg/dose=50unit/kg/dose >1000gm:once daily<1000gm:36hrlyCheck trough level with fourth dose(Roberton)
Inj Ceftazidime/Cefotaxime(250mg/2.5cc,500mg/5cc)   50mg/kg/dose     =0.5cc/kg/dose       =50unit/kg/dose 0-7days:12hrly  >7days:8hrly  
In meningitis:100mg/kg/dose                      =1cc/kg/dose
Inj Amikacin (Kacin,Amikin:100,250,500mg/2cc)  7.5mg/kg/dose     =0.15cc/kg/dose(calculated by 100mg/2cc)=15unit/kg/dose 12hrly  
OR15 mg/kg/dose=0.30cc/kg/dose=  30unit/kg/dose   Once daily(Source: Roberton)Check trough level with fourth dose(Source:Roberton)
Inj Meropenem( Ropenen,
20mg/kg/dose=0.4cc/kg/dose=40unit/kg/dose  0-14days:12hrly  >14days:8hrly  (source:NEOFAX 2010) Infuse over 30 minutes
In meningitis:40mg/kg/dose                       =0.8cc/kg/dose                       =80unit/kg/dose 
Inj Imipenem/cilastatin(500mg/100cc)  20mg/kg/dose=4cc/kg/dose 12hrly Infuse over 30 minutes
(In meningitis:Dose&Frequency same) 
Inj Vancomycin(500mg/10cc)   10mg/kg/dose=0.2cc/kg/dose=20unit/kg/dose 0-14days:12hrly  >14days:8hrly  (source:NEOFAX 2010)Always infuse over 1 hr 

Check trough level with fourth dose(Source:Roberton)

In meningitis:15mg/kg/dose                        =0.3cc/kg/dose                        =30unit/kg/dose



Inj Netilmicin(200,50mg/2cc)  2.5mg/kg/dose=0.025cc/kg/dose(calculated by 200mg/2cc)           =2.5unit/kg/dose 0-7days:12hrly  >7days:8hrly       (source:Gomella)
OR5mg/kg/dose=0.05cc/kg/dose=  5unit/kg/dose    


  Once daily Check trough level with fourth dose(source:Roberton)


Inj Ciprofloxacin(Neofloxacin:200mg/100cc) 7.5mg/kg/dose=3.75cc/kg/dose 12hrlyInfuse over 30 minutes
Inj Clarithromicin(Klaricid:500mg/10cc) 7.5mg/kg/dose= 0.15cc/kg/dose 12hrlyAlways infuse over 1 hr 
Inj Colistin(1million=10,00000unit/10cc)  25,000unit/kg/dose=0.25cc/kg/dose=25unit/kg/dose(by 100 unit insulin syringe) 8hrly Infuse over 30 minutes
Inj Cefepime(Tetracef,ceftipime:500mg/10cc)   50mg/kg/dose=1cc/kg/dose  12hrlyInfuse over 30 minutes
 In meningitis:Dose& Frequency same 
Inj Piperacillin-Tazobactam (Zosyn:4.5gm/20cc diluent)Piperacillin:4gmTazobactam:0.5gm  80mg/kg/dose(piperacilin component) =0.4cc/kg/dose=40unit/kg/dose  12hrlyRange:50-100mg/kg/dose   (piperacillin component) Infuse over 30 minutes  
 Inj Linezolid(Arlin:600mg/300ml)   10mg/kg/dose                                      12 hrlyInfuse over 30 minutes  



                   DRUGS                       DOSE INTERVAL
  Inj Metronidazole(Filmet,Mez:500mg/100cc)   7.5mg/kg/dose=1.5cc/kg/dose   
≤29wks 0-28days>28 48 hrs24
30-36 0-14>14 2412
≥37 0-7>7 2412
Inj Acyclovir(Xovir,Zovirax:500mg/10cc)  20mg/kg/dose=0.4cc/kg/dose=40unit/kg/dose 8hrlyAlways infuse over 1 hr  
   Inj Flucloxacillin Fluclox,Phylopen:250mg/2.5cc,500mg/5cc  50 mg/kg/dose=0.5cc/kg/dose=50unit/kg/dose 12 hrly
In Osteomyelitis: 100mg/kg/dose                              =1cc/kg/dose  6hrly over 4-6 wks)(Source: Roberton) 



DRUGS DOSES                          INTERVAL
Inj Phytomenadion(Inj Konakion:2mg/0.2cc)   Prophylaxis:                                         At birth:    2mg=0.2cc=20units,PO  stat or    1mg=0.1cc=10units,IV    statOn D4   :doOn D28 :do RESCUE:Treatment should be continued three consecutive days±FFP/PLT
Infant of diabetic MOMASYMPTOMATIC HYPOGLYCEMIAJJCBG <2mmol/l on at least 2 consecutive sample but no clinical signsA)If baby is on feeding      Continue supervised BF

      Increase feed volume and frequency

       Monitor prefeed CBG at least 2 hrly

                                  If not corrected

Open IV channel with 10% dextrose@GIR 6-8mg/kg/min

B)If baby is on IV fluid

     Increase conc or infusion rate


SYMPTOMATIC HYPOGLYCEMIA JJCBG <1mmol/l and/Clinical signs  –Repeat CBG(always imperative)  –Blood sample should be sent in lab for accurate BG level BUT sould not wait for result.

   –Bolus 10% IV glucose(2ml/kg)………AIIMS

   –Immediately after bolus,a glucose infusion rate 6 mg/kg/min

–Hrly blood glucose monitoring untill ≥2mmol/l

  –Investigate possible causes(eg.  Sepsis)

   –Subsequent hypoglycemic episodes may be treated by increasing the GIR by 2 mg/kg/min till a maximum of 12 mg/kg/min

 –If two or more consecutive values are normal(>50 mg/dl) after 24hrs of parenteral therapy,the infusion can be tapered off at the rate off 2mg/kg/min every 6 hrs with glucose monitoring 

Glucose monitoring in IDMAt birth2 hrly×3     D:16 hrly×312hrly×2    D:2

24hrly×1    D:3- subsequent

When should screening be stopped?

At the ends of 72 hrs in at risk babies

After stopping of the IV fluid ,baby is on full feed and has two consecutive values >50 mg/dl

Indications IV fluid:

Symptomatic hypoglycemia

CBG <1.7 mmol/l

Hypoglycemia persisting despite feeding

Unable/Contra-indications to feeding



                   DRUGS                       DOSE                      INTERVAL
Infant of HBsAg positive MOM    



AT BIRTHInj Immunoglobulin(Hepabig):0.5cc(  100 unit) IM in RT anteriolateral thigh Inj Antigen(Engerix):0.5cc(10 unit) ) IM in LT anteriolateral thigh

  –Repeat at 1M, 6M or

  –Vaccination should be submerged in EPI schedule(6,10,14 wks)

AT 9-18 month: HBsAg  and Anti-HBs should be doneIf HBsAg(+): Child Should be re-evaluatedIf Anti-HBs(+): Child is immune to HBSIf both HBsAg and    Anti-HBs(–): Repeat complete hepatitis B vaccine series     (source: Nelson)
Tab.Digoxin(Lenoxin:1 tab=0.25mg) Syp.Digoxin(syp centoxin=0.25mg/ml)




(Dixin:1 amp=0.25mg/2ml)


  Preterm TERM
  IV(µg/kg/day) Oral IV Oral
Total digitalizing dose(TDD) 15-25 20-30 0-30 25-35
Maintenance dose 4-6 5-7.5 5-8 6-10
TDD is to be divided 1/2, 1/4 and 1/4every 8 hrs Oral dose is 25% higher than iv doseIndications:

  • CCF
  • Atrial fibrillation
  • SVT                                (source: Gomella)
Frusemide+Spironolactone(Frulac/Lasilactone:1 tab=20/50mg)  Frusemide= 1mg/kg/doseSpironolactone=1-2mg/kg/dose 12 hrly or once dailySource:Roberton 
Captopril(Acetor,Cardopril:1 tab=25mg)  0.01-0.05mg/kg/dose 8-12 hrly



                   DRUGS                       DOSE                      INTERVAL
                                                                                                                             Inj Phenobarbitone(Barbit:200mg/cc) Loading         =20mg/kg/dose                       =0.1cc/kg/dose                       =10unit/kg/dose    
Maintenance=2.5mg/kg/dose                      =1.5unit/kg/doseN.B:10mg/kg/dose=5unit/kg/dose                   12hrly
Inj Fosphenytoin(Fosphen:150mg/2cc) Loading         =30mg/kg/dose                       =0.4cc/kg/dose                       =40unit/kg/dose    
 Maintenance=3.75mg/kg/dose                        =5unit/kg///doseN.B:15mg/kg/dose=20unit/kg/dose                    12hrly                                
Inj Ranitidine(Ranison,Neotack:50mg/2cc)   1mg/kg/dose=4unit/kg/dose                 12hrly                Source:Gomella p-779
Inj Frusemide(Lasix:20mg/2cc)                         1mg/kg/dose                      =10unit/kg/dose  


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