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Doses of antibiotics for the treatment of suspected Staphylococcus aureus or streptococcal skin and soft tissue infections in children

Doses of antibiotics for the treatment of suspected Staphylococcus aureus or streptococcal skin and soft tissue infections in children
Antimicrobial agent Regimen[1-5]
Parenteral therapy
Cefazolin
  • 50 to 100 mg/kg per day IV in 3 doses (maximum daily dose 3 g)
Ceftaroline
  • 2 months to <2 years: 24 mg/kg per day IV in 3 doses
  • ≥2 years to <18 years:
    • ≤33 kg: 36 mg/kg per day IV in 3 doses
    • >33 kg: 400 mg every 8 hours IV or 600 mg every 12 hours IV
Ceftriaxone
  • 75 to 100 mg/kg per day IV in 1 or 2 doses (maximum daily dose 4 g)
Clindamycin
  • 30 to 40 mg/kg per day IV in 3 to 4 doses (maximum daily dose 2.7 g)
Dalbavancin
  • Birth through 5 years: 22.5 mg/kg IV in a single infusion
  • 6 through 17 years: 18 mg/kg IV in a single infusion
Daptomycin
  • 1 through 5 years: 10 mg/kg once per day IV
  • ≥6 years: 4 to 6 mg/kg once per day IV
Linezolid
  • <12 years: 30 mg/kg per day IV in 3 doses
  • ≥12 years: 600 mg twice per day IV
Nafcillin
  • 150 to 200 mg/kg per day IV in 4 to 6 doses (maximum daily dose 12 g)
Oxacillin
  • 150 to 200 mg/kg per day IV in 4 to 6 doses (maximum daily dose 12 g)
Tedizolid
  • For patients ≥12 years of age: 200 mg per dose IV once per day
Vancomycin
  • Refer to UpToDate content related to alternative methods of dosing vancomycin for children older than 28 days*
Oral therapy
Amoxicillin
  • 40 to 50 mg/kg per day orally in 3 doses (maximum daily dose 1.5 g)
Cefadroxil
  • 30 mg/kg per day orally in 2 divided doses (maximum daily dose 2 g)
Cefuroxime
  • 30 mg/kg per day orally in 2 doses (maximum daily dose 1 g)
Cephalexin
  • 25 to 100 mg/kg per day orally in 3 or 4 doses (maximum daily dose 2 g)
Clindamycin
  • 30 to 40 mg/kg per day orally in 3 or 4 doses (maximum daily dose 1.8 g)
Cloxacillin (not available in the United States)
  • 25 to 50 mg/kg per day orally in 4 doses (maximum daily dose 2 g)
DoxycyclineΔ
  • 2 to 4 mg/kg per day orally in 1 or 2 doses (maximum daily dose 200 mg)
Linezolid
  • <12 years: 30 mg/kg per day orally in 3 doses
  • ≥12 years: 600 mg twice per day orally
Penicillin V
  • 25 to 75 mg/kg per day orally in 3 or 4 doses (maximum daily dose 2 g)
Tedizolid
  • For patients ≥12 years of age: 200 mg/dose orally once per day
TMP-SMX
  • 8 to 12 mg/kg per day orally of TMP, 40 to 60 mg/kg per day of SMX (maximum daily dose 320 mg of TMP, 1.6 g of SMX)
Refer to UpToDate content on treatment of SSTI in children for information regarding choice of antimicrobial therapy. The doses above are intended for patients with normal organ function. The dose of daptomycin, vancomycin, and linezolid must be adjusted in the setting of renal insufficiency. Refer to the Lexicomp monographs included with UpToDate for specific recommendations.

IV: intravenous; TMP-SMX: trimethoprim-sulfamethoxazole; SSTI: skin and soft tissue infection; AUC: area under the curve; MSSA: methicillin-susceptible S. aureus.

* The approach to vancomycin dosing is generally determined at the institutional level. Refer to UpToDate content on invasive staphylococcal infections in children for details of trough-guided and AUC-guided vancomycin dosing.

¶ Use doses on the higher end of the range for more severe infection or when MSSA is suspected.[6]

Δ Tetracycline antibiotics may cause permanent tooth discoloration for children <8 years if used repeatedly. However, doxycycline binds less readily to calcium than other tetracyclines and may be used for ≤21 days in children of all ages.[7]
References:
  1. American Academy of Pediatrics. Tables of antibacterial drug dosages. In: Red Book: 2021-2024 Report of the Committee on Infectious Diseases, 32nd ed, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics, Itasca, IL 2021. p.876.
  2. Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011; 52:e18.
  3. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:147.
  4. Sivextro (tedizolid phosphate) package insert. Whitehouse Station, NJ: Merck Sharp & Dohme Corp; 2020.
  5. Dalvance (dalbavancin) package insert. Madison, NJ: 2021: Allergan USA, Inc; 2021.
  6. Trottier ED, Farley St-Amand B, Vincent M, et al. Outpatient management of moderate cellulitis in children using high-dose oral cephalexin. Paediatr Child Health. 2022; 27:213.
  7. American Academy of Pediatrics. Tetracyclines. In: Red Book: 2021-2024 Report of the Committee on Infectious Diseases, 32nd ed, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics, Itasca, IL 2021. p.866.
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