Antibiotics Dosing Guidelines

Antibiotic Dosages

• Amikacin:

  • Children: 15 mg/kg (max 1.5 g) once daily via IM or slow IV
  • Adults: 15 mg/kg once daily via slow IV over 3 mins.

• Ampicillin:

  • Children: 50 mg/kg (max 2 g) every 8 hours via IV infusion over 30 mins
  • Adults: 2 g every 6-8 hours (2 g every 4 hours for meningitis).

• Azithromycin:

  • Children: 10-20 mg/kg (max 500 mg) once daily via PO or NGT
  • Adults: 500 mg to 1 g once daily.

• Cefazolin:

  • Children: 25 mg/kg (max 3 g) every 12 hours via slow IV or IV infusion
  • Adults: 2 g every 8 hours.

• Ceftriaxone:

  • Children: 80 mg/kg (max 4 g) once daily (100 mg/kg max for meningitis)
  • Adults: 2 g once daily (2 g every 12 hours for meningitis).

• Ciprofloxacin:

  • Children: 15-20 mg/kg (max 750 mg) every 12 hours via PO or NGT
  • Adults: 500-750 mg every 12 hours via PO or 400 mg every 8-12 hours IV.

• Clindamycin:

  • Children: 10 mg/kg (max 600 mg) every 8 hours via IV infusion
  • Adults: 600-900 mg every 8 hours.

• Cloxacillin:

  • Children: 25-50 mg/kg (max 2 g) every 6 hours via IV infusion
  • Adults: 2 g every 6 hours.

• Doxycycline:

  • Children: 4.4 mg/kg (max 200 mg) on day 1, then 2.2 mg/kg (max 100 mg) every 12 hours via PO or NGT
  • Adults: 200 mg on day 1, then 100 mg every 12 hours.

• Gentamicin:

  • Children: 7.5 mg/kg once daily via IM or slow IV
  • Adults: 5 mg/kg once daily.

• Meropenem:

  • Children: 20 mg/kg (max 2 g) every 8 hours via IV infusion
  • Adults: 2 g every 8 hours.

• Metronidazole:

  • Children: 10 mg/kg (max 500 mg) every 8 hours via PO or IV infusion
  • Adults: 500 mg every 8 hours.

• Vancomycin:

  • Children: 15 mg/kg (max 500 mg) every 6 hours via IV infusion over 60-240 minutes
  • Adults: 15-20 mg/kg (max 2 g) every 12 hours.

Cardiogenic Shock Management

• Fluid Administration:

  • Administer RL cautiously, monitor for fluid overload.
  • Adults: 100-250 ml over 30 mins; adjustments based on assessment (urinary output, mental status, SpO2).

• Clinical Features of Shock:

  • Hypotension: weak pulse, low BP, narrow pulse pressure.
  • Tissue hypoperfusion signs:
    • Skin: pallor, cold extremities, CRT ≥ 3 seconds.
    • Lungs: tachypnea, dyspnea.
    • Heart: tachycardia precedes BP drop.
    • Kidney: oliguria (< 0.5 to 1 ml/kg/hour) or anuria.
    • Brain: altered mental states, anxiety, thirst.

• Shock in Children:

  • Hypotension is a late sign; treat if presenting with: lower limb temperature gradient, CRT ≥ 3 seconds, weak radial pulse, or severe tachycardia.

Specific Shock Types

• Anaphylaxis:

  • Recent allergen exposure; skin/mucous membrane involvement along with respiratory symptoms or low BP.

• Distributive Shock:

  • Severe vasodilation, increased capillary permeability with risk factors like recent allergen exposure, or infections.

Basic Life Support Steps

• Manage airways and breathing; position the patient appropriately.
• If anaphylaxis is suspected, immediately address it.
• Monitor vital signs, including urine output, HR, RR, BP, and SpO2.

Antibiotic Administration Guidelines

• First-line treatments specified, including combinations for children (ampicillin + gentamicin, ceftriaxone).
• Alternative regimens for adults based on risk factors and antibiotic availability.

Morphine Dosing

• Immediate Release (MIR):

  • Children > 6 months: 0.15 mg/kg every 4 hours.
  • Adults: 10 mg every 4 hours, adjust based on pain intensity.

• Sustained Release (MSR):

  • Daily doses for elderly and those with renal/hepatic impairment should be halved.

Additional Considerations

• Administer a laxative if morphine treatment exceeds 48 hours.
• Attention to changes in condition; re-evaluate every 10 minutes until stability is achieved.