Medications: General & Antibiotics

COMMONLY USED DRUGS FOR INFANTS IN THE NICU

ANTIBIOTICS & ANTIFUNGALS | GENTAMICIN DOSING TABLE

BRAND NAME GENERIC NAME BRAND NAME GENERIC NAME

Aldactone Spironolactone Lasix Furosemide

Anectine Succinylcholine Narcan Naloxone

Apresoline Hydralazine Nipride Nitroprusside

Ativan Lorazepam Nystatin Mycostatin

Bumex Bumetanide Pavulon Pancuronium

Claforan Cefotaxime Propulsid Cisapride

Cerebyx Fosphenytoin Ventolin Albuterol

Decadron Dexamethasone Solu-Cortef Hydrocortisone

Diamox Acetazolamide Solu-Medrol Methylprednisolone

Diuril Chlorothiazide Valium Diazepam

Epogen Erythropoeitin Versed Midazolam

Intal Cromolyn Zantac Ranitidine

DRUG

ROUTE

DOSAGE

COMMENTS

Acetaminophen PO, PR 10-15 mg/kg/doseq4-6h (max 5 doses/day)

Adenosine IV 50-250 mcg/kg/dose Rapid IV push

Albumin IV 5 % solution10 cc/kg
(1 gm/kg)

Albuterol Nebulization 5mg/ml solution 0.125-0.25mg in 2cc NS q2-8h Can use 1 vial (2 ml) of Cromolyn as diluent Use saline if more often than q6hr

Atropine IV, SQ Minimum dose: 0.10 mg Use before giving succinylcholine for elective intubation of older babies

Bumetanide IV 0.01-0.05mg/kg/day Continuous drip start at 5mcg/kg/hr and titrate

Caffeine Citrate PO 20 mg/kg loading dose, then 6-10 mg/kg q24 hours as maintenance dose Maintain blood levels between 8-20 µg/ml. Always specify Citrate for outpatient prescriptions.

Calcium Gluconate 10% (contains 9.3 mg elemental Ca++/ml) IV 100-200mg/kg/dose or
1-2 ml/kg/dose Administer slowly through central catheters. May give as infusion: 400-1000 mg/100 ml IV fluid

Chloral Hydrate PO, PR 20-75mg/kg/dose q6-8 hr Used for sedation; can cause gastric irritation or severe bronchospasm if aspirated

Chlorothiazide PO 20-40 mg/kg/day 10-20mg/kg/dose in two divided doses

Cisapride PO 0.1-0.3 mg/kg/dose q6-8 hr, 15-30 min before feeding if possible 0.2mg/kg/dose TID is routine starting dose. To facilitate gastric emptying, and diminish reflux

Cromolyn Nebulization 1 vial (20 mg/2 ml) q6-8h Can be used as diluent for albuterol nebs

D10W IV 2 cc/kg/dose

Dexamethasone IV, IM, PO 0.5 mg/kg/day in two divided doses Monitor serum glucose and BP. Wean when discontinuing.

Diazepam IV, PO Sedative: 0.02-0.3 mg/kg/dose q6-8h Seizures: 0.1-0.3 mg/kg/dose IV slow push up to total initial dose of 1.0 mg/kg Caution re: respiratory depression and hypotension

Digoxin PO, IV (Increase PO dose by 20%) TDD:
<1.5 kg: 15 µg/kg
1.5-2.5 kg: 20 µg/kg
Term: 35 µg/kg Maintenance:
1/8 TDD q12h (begin12h after last digitalizing dose) Side Effects: conduction defects, emesis, or ventricular arrhythmias.Check with individual Cardiologists regarding their preference of TDD and maintenance dose.

Dobutamine IV 2.5-20 µg/kg/min See formula below

Dopamine IV 2.5-20 µg/kg/min See formula below

Amount of drug in mg added to 100 ml of IV fluid :
? mg/100ml IV fluid = [Weight (kg) x 6 x dosage(mcg/kg/min)] / IV infusion rate (ml/hr)

Erythropoeitin SQ 200 U/kg/dose 3x/wk See Epogen Protocol

Epinephrine(1:10,000) IV, ET Resuscitation:0.1-0.3 ml/kg/dose
Hypotension:0.01-0.1 µg/kg/min May dilute 1:1 with normal saline if given ET

Fentanyl IV 3.0-6.0 µg/kg/hr drip or 1-4 µg/kg/dose slow IV push q2-4 hr Consider wean when used >5 days

Fosphenytoin IV Load:20mg PE/kg in D5W, sterile water or NS
Maintenance: 5-7mg PE/kg/day Dose is in Phenytoin Equivalents (PE); maintain levels between 10-20 µg/ml

Furosemide IV, IM, PO 1-2 mg/kg/dose q12-24h (prolonged half-life in VLBW infants) Oral dosage is 2x IV dose. Monitor Na+, K+, Cl- HCO3-, blood gases

Glucagon IM, IV 0.03 mg/kg/dose
Max dose: 1.0 mg/kg IDM may require 0.3 mg/kg

Hydralazine IV, PO 0.1-0.5 mg/kg/dose q6h
Max dose of 2.0 mg/kg/dose (8mg/kg/day) May cause reflex tachycardia

Hydrocortisone IM, IV, PO Stress Dose/Adrenal Crisis: 3-10 mg/kg/day
Physiologic replacement: 1 mg/kg/day or 15-25 mg/m2/day 5 mg/kg initially then 2.5 mg/kg/dose q6h x 48-72 hours post-op

Indomethacin IV IVH Prophylaxis:
0.1 mg/kg/day x 3 days
PDA Treatment: See Protocol Infants <1250gm receive prophylaxis

Iron(Fer-in-Sol® drops) PO Preemies: 2 mg/kg/day
On EPO: 4-6mg/kg/day May cause guaiac+ stools

Kayexalate® Per rectum 1-2 gm/kg Administer q2-4h Exchange resin that decreases K+ but increases Na+

Lorazepam IV 0.05-0.10 mg/kg q 6-8h infused over 2-5 min AnticonvulsantSedation

Methylprednisolone IM, IV Septic Shock: 10-30 mg/kg/dose q6h
Airway inflammation:
1-2 mg/kg/dose q12h

Midazolam IV, (IM) 0.05-0.1 mg/kgq2-4hr prn Shorter duration of action, less obtundation and respiratory depression than Valium

Morphine IV, IM, SQ 0.05-0.1 mg/kg/dose q3-6h May cause prolonged depression in premature infants

Mycostatin PO 100,000 units q6h To treat thrush

Naloxone IV, IM, ET 0.1 mg/kg/dose May need to repeat

Neostigmine IV 0.05 mg/kg/dose Reverses Pancuronium; administer with Atropine

Nitroprusside IV Start infusion at 0.05-1.0 µg/.kg/min and titrate according to blood pressure and oxygenation Caution : hypotension and thiocyanate toxicity

Pancuronium IV 0.1 mg/kg/dose May repeat as necessary for paralysis

Phenobarbital IV, IM, PO Loading dose: 15-20 mg/kg (repeat 10mg/kg doses if sz continues, up to total of 40 mg/kg)
Maintenance: 5-6 mg/kg/day as 1 dose Therapeutic levels between 20-40 µg/mlGet level after 2nd bolus if multiple doses are given

Prostaglandin E1 IV 0.05-0.1 µg/kg/min in D5W or NS *[0.05 µg/kg/min = 150 x wt(kg) in 50cc D5W @ 1cc/h] Can be given via UAC

Ranitidine PO, IV 1-2 mg/kg/dose q8-12h

Sodium Bicarbonate IV (PO dose follows) 1-3 mEq/kg/dose, or Base deficit x 0.3 x weight in kg÷2 Dilute at least 1:1 with sterile water; do not administer more rapidly than 1 mEq/kg/min

Sodium Bicarbonate PO (IV dose precedes) Base deficit x 0.3 x weight in kg÷2 Daily oral dosage should be equally divided into 3 or 4 doses and administered with feedings

Spironolactone PO 1-2 mg/kg/dose q 12h Monitor serum K+

Succinylcholine IV, IM, SQ 1-2 mg/kg/dose Do not use in infants with hyperkalemia and/or arrhythmias. Precede succinylcholine with atropine

Theophylline
Aminophylline PO
IV Loading dose:8 mg/kg
Maintenance:
3-6 mg/kg/day q8hr
(begin 8-12 hr after load). Maintain blood levels between 4.5 - 10 µg/ml (trough level in 2-3 days or by clinical indications)

Vecuronium IV 0.1 mg/kg Shorter acting than Pavulon; less hypertension and tachycardia

Vitamin K1 IM, IV 1 mg IV infuse very slowly

ANTIBIOTICS &ANTIFUNGALS Route < 1 Week of Age > 1 Week of Age

Acyclovir IV 30 mg/kg/day q8h Same

Amphotericin B IV Test dose: 0.1 mg/kg
Initial: 0.25 mg/kg/day
Increment: 0.125mg/kg/day All infants are reviewed with ID regarding duration of Rx and need for 5-FC

Ampicillin 2 IV, IM 100 mg/kg/day q12h 100 mg/kg/day q8h

Cefazolin IV 40 mg/kg/day q12h 80 mg/kg/day q12h

Cefotaxime IV, IM 100 mg/kg/day q12h 150 mg/kg/day q8h

Clindamycin IV, IM <2000 gm: 10 mg/kg/day
>2000 gm: 15 mg/kg/day q8h <2000 gm: 15 mg/kg/day q8h
>2000 gm: 20 mg/kg/day q6h

Erythromycin ethylsuccinate (EES®) PO 40 mg/kg/dayq6h May interfere with theophylline levels

5-FC PO 20-40 mg/kg/dose q6hr All infants are reviewed with ID

Gentamicin 4 IV3, IM See Dosing Table

Oxacillin IV 25-50 mg/kg/dose q 12h 25-50 mg/kg/dose q6-8h

Penicillin G 1 IV, IM 50,000 U/kg/day q12h 75-100,000 U/kg/day q8h

Ticarcillin IV, IM <2000 gm: 150 mg/kg/day q12h
>2000 gm: 225 mg/kg/day q8h <2000 gm: 225 mg/kg/day q8h
>2000 gm: 300 mg/kg/day q6h

Vancomycin 5 IV 10-15 mg/kg/dose <1 kg : q24h
>1 kg: q12h
>2 kg: q12h

Footnotes for above table:

For Group B Strep sepsis, increase dose to 200-300,000U/kg/day q6-12h; for meningitis, 300 - 400,000/kg/day q6-12h.
For group B Strep sepsis meningitis, increase dose to 200 mg/kg/day q8-12h.
Give over one hour. Please check dosing table for exact doses and intervals.
Obtain peak and trough levels if to be given >3 days.
Obtain trough level if to be given >3 days. CSF infection may also require a peak level.

GENTAMICIN DOSING TABLE FOR INFANTS*

For neonates < 7 days of age:

For neonates > 7 days of age:

< 1250 grams:

Dose with 3.5 mg/kg/dose every 48 hours
Obtain gentamicin levels if treating >72 hours
Contact pharmacy regarding timing of gentamicin levels
< 1250 grams:

Dose with 2.5-3 mg/kg/dose every 24 hours
No gentamicin levels until after culture results are know

1250 - 2000 grams:

Dose with 3-3.5 mg/kg/dose every 24 hours
Obtain gentamicin levels if treating > 72 hours
>1250 grams:

Dose with 2.5 mg/kg/dose every 12 hours
No gentamicin levels until after culture results are known

>2000 grams:

Dose with 3.5 mg/kg/dose every 24 hours
Obtain gentamicin levels if treating > 72 hours

For ANY neonate with renal dysfunction or significant asphyxia at birth:
Dose with 3.5 mg/kg/dose - one dose only
Contact pharmacy for gentamicin levels and maintenance dosing

* Use standardized dosing table to round dose to nearest increment

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BRAND NAME	GENERIC NAME	BRAND NAME	GENERIC NAME
Aldactone	Spironolactone	Lasix	Furosemide
Anectine	Succinylcholine	Narcan	Naloxone
Apresoline	Hydralazine	Nipride	Nitroprusside
Ativan	Lorazepam	Nystatin	Mycostatin
Bumex	Bumetanide	Pavulon	Pancuronium
Claforan	Cefotaxime	Propulsid	Cisapride
Cerebyx	Fosphenytoin	Ventolin	Albuterol
Decadron	Dexamethasone	Solu-Cortef	Hydrocortisone
Diamox	Acetazolamide	Solu-Medrol	Methylprednisolone
Diuril	Chlorothiazide	Valium	Diazepam
Epogen	Erythropoeitin	Versed	Midazolam
Intal	Cromolyn	Zantac	Ranitidine

	For neonates < 7 days of age:		For neonates > 7 days of age:
< 1250 grams:	Dose with 3.5 mg/kg/dose every 48 hours Obtain gentamicin levels if treating >72 hours Contact pharmacy regarding timing of gentamicin levels	< 1250 grams:	Dose with 2.5-3 mg/kg/dose every 24 hours No gentamicin levels until after culture results are know
1250 - 2000 grams:	Dose with 3-3.5 mg/kg/dose every 24 hours Obtain gentamicin levels if treating > 72 hours	>1250 grams:	Dose with 2.5 mg/kg/dose every 12 hours No gentamicin levels until after culture results are known
>2000 grams:	Dose with 3.5 mg/kg/dose every 24 hours Obtain gentamicin levels if treating > 72 hours

DRUG	ROUTE	DOSAGE	COMMENTS
Acetaminophen	PO, PR	10-15 mg/kg/doseq4-6h	(max 5 doses/day)
Adenosine	IV	50-250 mcg/kg/dose	Rapid IV push
Albumin	IV	5 % solution10 cc/kg (1 gm/kg)
Albuterol	Nebulization	5mg/ml solution 0.125-0.25mg in 2cc NS q2-8h	Can use 1 vial (2 ml) of Cromolyn as diluent Use saline if more often than q6hr
Atropine	IV, SQ	Minimum dose: 0.10 mg	Use before giving succinylcholine for elective intubation of older babies
Bumetanide	IV	0.01-0.05mg/kg/day	Continuous drip start at 5mcg/kg/hr and titrate
Caffeine Citrate	PO	20 mg/kg loading dose, then 6-10 mg/kg q24 hours as maintenance dose	Maintain blood levels between 8-20 µg/ml. Always specify Citrate for outpatient prescriptions.
Calcium Gluconate 10% (contains 9.3 mg elemental Ca++/ml)	IV	100-200mg/kg/dose or 1-2 ml/kg/dose	Administer slowly through central catheters. May give as infusion: 400-1000 mg/100 ml IV fluid
Chloral Hydrate	PO, PR	20-75mg/kg/dose q6-8 hr	Used for sedation; can cause gastric irritation or severe bronchospasm if aspirated
Chlorothiazide	PO	20-40 mg/kg/day	10-20mg/kg/dose in two divided doses
Cisapride	PO	0.1-0.3 mg/kg/dose q6-8 hr, 15-30 min before feeding if possible	0.2mg/kg/dose TID is routine starting dose. To facilitate gastric emptying, and diminish reflux
Cromolyn	Nebulization	1 vial (20 mg/2 ml) q6-8h	Can be used as diluent for albuterol nebs
D10W	IV	2 cc/kg/dose
Dexamethasone	IV, IM, PO	0.5 mg/kg/day in two divided doses	Monitor serum glucose and BP. Wean when discontinuing.
Diazepam	IV, PO	Sedative: 0.02-0.3 mg/kg/dose q6-8h Seizures: 0.1-0.3 mg/kg/dose IV slow push up to total initial dose of 1.0 mg/kg	Caution re: respiratory depression and hypotension
Digoxin	PO, IV (Increase PO dose by 20%)	TDD: <1.5 kg: 15 µg/kg 1.5-2.5 kg: 20 µg/kg Term: 35 µg/kg Maintenance: 1/8 TDD q12h (begin12h after last digitalizing dose)	Side Effects: conduction defects, emesis, or ventricular arrhythmias.Check with individual Cardiologists regarding their preference of TDD and maintenance dose.
Dobutamine	IV	2.5-20 µg/kg/min	See formula below
Dopamine	IV	2.5-20 µg/kg/min	See formula below

Erythropoeitin	SQ	200 U/kg/dose 3x/wk	See Epogen Protocol
Epinephrine(1:10,000)	IV, ET	Resuscitation:0.1-0.3 ml/kg/dose Hypotension:0.01-0.1 µg/kg/min	May dilute 1:1 with normal saline if given ET
Fentanyl	IV	3.0-6.0 µg/kg/hr drip or 1-4 µg/kg/dose slow IV push q2-4 hr	Consider wean when used >5 days
Fosphenytoin	IV	Load:20mg PE/kg in D5W, sterile water or NS Maintenance: 5-7mg PE/kg/day	Dose is in Phenytoin Equivalents (PE); maintain levels between 10-20 µg/ml
Furosemide	IV, IM, PO	1-2 mg/kg/dose q12-24h (prolonged half-life in VLBW infants) Oral dosage is 2x IV dose.	Monitor Na+, K+, Cl- HCO3-, blood gases
Glucagon	IM, IV	0.03 mg/kg/dose Max dose: 1.0 mg/kg	IDM may require 0.3 mg/kg
Hydralazine	IV, PO	0.1-0.5 mg/kg/dose q6h Max dose of 2.0 mg/kg/dose (8mg/kg/day)	May cause reflex tachycardia
Hydrocortisone	IM, IV, PO	Stress Dose/Adrenal Crisis: 3-10 mg/kg/day Physiologic replacement: 1 mg/kg/day or 15-25 mg/m2/day	5 mg/kg initially then 2.5 mg/kg/dose q6h x 48-72 hours post-op
Indomethacin	IV	IVH Prophylaxis: 0.1 mg/kg/day x 3 days PDA Treatment: See Protocol	Infants <1250gm receive prophylaxis
Iron(Fer-in-Sol® drops)	PO	Preemies: 2 mg/kg/day On EPO: 4-6mg/kg/day	May cause guaiac+ stools
Kayexalate®	Per rectum	1-2 gm/kg Administer q2-4h	Exchange resin that decreases K+ but increases Na+
Lorazepam	IV	0.05-0.10 mg/kg q 6-8h infused over 2-5 min	AnticonvulsantSedation
Methylprednisolone	IM, IV	Septic Shock: 10-30 mg/kg/dose q6h Airway inflammation: 1-2 mg/kg/dose q12h
Midazolam	IV, (IM)	0.05-0.1 mg/kgq2-4hr prn	Shorter duration of action, less obtundation and respiratory depression than Valium
Morphine	IV, IM, SQ	0.05-0.1 mg/kg/dose q3-6h	May cause prolonged depression in premature infants
Mycostatin	PO	100,000 units q6h	To treat thrush
Naloxone	IV, IM, ET	0.1 mg/kg/dose	May need to repeat
Neostigmine	IV	0.05 mg/kg/dose	Reverses Pancuronium; administer with Atropine
Nitroprusside	IV	Start infusion at 0.05-1.0 µg/.kg/min and titrate according to blood pressure and oxygenation	Caution : hypotension and thiocyanate toxicity
Pancuronium	IV	0.1 mg/kg/dose	May repeat as necessary for paralysis
Phenobarbital	IV, IM, PO	Loading dose: 15-20 mg/kg (repeat 10mg/kg doses if sz continues, up to total of 40 mg/kg) Maintenance: 5-6 mg/kg/day as 1 dose	Therapeutic levels between 20-40 µg/mlGet level after 2nd bolus if multiple doses are given
Prostaglandin E1	IV	0.05-0.1 µg/kg/min in D5W or NS *[0.05 µg/kg/min = 150 x wt(kg) in 50cc D5W @ 1cc/h]	Can be given via UAC
Ranitidine	PO, IV	1-2 mg/kg/dose q8-12h
Sodium Bicarbonate	IV (PO dose follows)	1-3 mEq/kg/dose, or Base deficit x 0.3 x weight in kg÷2	Dilute at least 1:1 with sterile water; do not administer more rapidly than 1 mEq/kg/min
Sodium Bicarbonate	PO (IV dose precedes)	Base deficit x 0.3 x weight in kg÷2	Daily oral dosage should be equally divided into 3 or 4 doses and administered with feedings
Spironolactone	PO	1-2 mg/kg/dose q 12h	Monitor serum K+
Succinylcholine	IV, IM, SQ	1-2 mg/kg/dose	Do not use in infants with hyperkalemia and/or arrhythmias. Precede succinylcholine with atropine
Theophylline Aminophylline	PO IV	Loading dose:8 mg/kg Maintenance: 3-6 mg/kg/day q8hr (begin 8-12 hr after load).	Maintain blood levels between 4.5 - 10 µg/ml (trough level in 2-3 days or by clinical indications)
Vecuronium	IV	0.1 mg/kg	Shorter acting than Pavulon; less hypertension and tachycardia
Vitamin K1	IM, IV	1 mg	IV infuse very slowly

ANTIBIOTICS &ANTIFUNGALS	Route	< 1 Week of Age	> 1 Week of Age
Acyclovir	IV	30 mg/kg/day q8h	Same
Amphotericin B	IV	Test dose: 0.1 mg/kg Initial: 0.25 mg/kg/day Increment: 0.125mg/kg/day	All infants are reviewed with ID regarding duration of Rx and need for 5-FC
Ampicillin 2	IV, IM	100 mg/kg/day q12h	100 mg/kg/day q8h
Cefazolin	IV	40 mg/kg/day q12h	80 mg/kg/day q12h
Cefotaxime	IV, IM	100 mg/kg/day q12h	150 mg/kg/day q8h
Clindamycin	IV, IM	<2000 gm: 10 mg/kg/day >2000 gm: 15 mg/kg/day q8h	<2000 gm: 15 mg/kg/day q8h >2000 gm: 20 mg/kg/day q6h
Erythromycin ethylsuccinate (EES®)	PO	40 mg/kg/dayq6h	May interfere with theophylline levels
5-FC	PO	20-40 mg/kg/dose q6hr	All infants are reviewed with ID
Gentamicin 4	IV3, IM	See Dosing Table
Oxacillin	IV	25-50 mg/kg/dose q 12h	25-50 mg/kg/dose q6-8h
Penicillin G 1	IV, IM	50,000 U/kg/day q12h	75-100,000 U/kg/day q8h
Ticarcillin	IV, IM	<2000 gm: 150 mg/kg/day q12h >2000 gm: 225 mg/kg/day q8h	<2000 gm: 225 mg/kg/day q8h >2000 gm: 300 mg/kg/day q6h
Vancomycin 5	IV	10-15 mg/kg/dose	<1 kg : q24h >1 kg: q12h >2 kg: q12h