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Antibiotic dosing for invasive Listeria infection

Antibiotic dosing for invasive Listeria infection
  Infants ≤7 days of age Infants 8 to 28 days of age Infants 29 to 60 days of age Infants and children >60 days of age Nonpregnant adults
Ampicillin Patients in whom CNS infection has been documented or not yet excluded:
  • 300 mg/kg per day IV in 3 divided doses
Patients in whom CNS infection has been excluded (weight-directed dosing)*:
  • Weight ≤2 kg: 100 mg/kg per day IV in 2 divided doses
  • Weight >2 kg: 150 mg/kg per day IV in 3 divided doses
Patients in whom CNS infection has been documented or not yet excluded:
  • 300 mg/kg per day IV in 4 divided doses
Patients in whom CNS infection has been excluded (weight-directed dosing)*:
  • Weight ≤2 kg: 150 mg/kg per day IV in 2 divided doses
  • Weight >2 kg: 150 mg/kg per day IV in 3 divided doses
Patients in whom CNS infection has been documented or not yet excluded:
  • 300 mg/kg per day IV in 4 divided doses
Patients in whom CNS infection has been excluded:
  • 200 mg/kg per day IV in 4 divided doses

Patients in whom CNS infection has been documented or not yet excluded:

  • 300 to 400 mg/kg per day IV in 4 to 6 divided doses; maximum dose: 12 g per day

Patients in whom CNS infection has been excluded:

  • 200 mg/kg per day IV in 4 divided doses; maximum dose: 8 g per day
2 g IV every 4 hours
or
Penicillin G Patients in whom CNS infection has been documented or not yet excluded:
  • 450,000 units/kg/day IV in 3 divided doses
Patients in whom CNS infection has been excluded:
  • 100,000 units/kg/day IV in 2 divided doses
Patients in whom CNS infection has been documented or not yet excluded:
  • 400,000 to 500,000 units/kg/day IV in 4 divided doses
Patients in whom CNS infection has been excluded:
  • 150,000 units/kg/day IV in 3 divided doses
Patients in whom CNS infection has been documented or not yet excluded:
  • 400,000 to 500,000 units/kg/day IV in 4 divided doses
Patients in whom CNS infection has been excluded:
  • 200,000 units/kg/day IV in 4 divided doses
Patients in whom CNS infection has been documented or not yet excluded:
  • 400,000 to 500,000 units/kg per day IV in 4 to 6 divided doses; maximum dose: 24 million units per day; doses >400,000 units/kg per day are generally only used for infants <1 year of age
Patients in whom CNS infection has been excluded:
  • 250,000 to 300,000 units/kg/day IV in 4 to 6 divided doses; maximum dose: 24 million units per day
4 million units IV every 4 hours
plus (if CNS, bloodstream, or other serious infection)
  Infants ≤60 days of age Infants and children >60 days of age Nonpregnant adults
Gentamicin Gestational age <30 weeks:
  • Postnatal age ≤14 days: 5 mg/kg IV every 48 hours
  • Postnatal age >14 days: 5 mg/kg IV every 36 hours
Gestational age 30 to 34 weeks:
  • Postnatal age ≤10 days: 5 mg/kg IV every 36 hours
  • Postnatal age >10 to 60 days: 5 mg/kg IV every 24 to 36 hours
Gestational age ≥35 weeks:
  • Postnatal age ≤7 days: 4 mg/kg IV every 24 hours
  • Postnatal age >7 to 60 days: 5 mg/kg IV every 24 hours
7.5 mg/kg per day IV in 3 divided doses 5 mg/kg per day IV in 3 divided doses
Dosing in this table is for patients with normal renal function; infant dosing is for patients weighing ≥1 kg. For additional dosing detail, refer to the Lexicomp drug information monographs included within UpToDate.
CNS: central nervous system; IV: intravenously.
* For alternative gestational age-directed dosing, refer to the Lexicomp pediatric drug information monograph included within UpToDate.
¶ The optimal peak gentamicin levels in listerial infection are not known; the ranges presented are the opinions of our contributors:
  • For infants to ≤1 month of age, the desired gentamicin peak is 6 to 12 mcg/mL and the trough is <2 mcg/mL.
  • For infants and children >1 month of age, the desired gentamicin peak is 6 to 10 mcg/mL and the trough is <2 mcg/mL.
  • For nonpregnant adults, the desired gentamicin peak is 4 to 8 mcg/mL and the trough is <2 mcg/mL (ideally <1 mcg/mL). While the target serum gentamicin peak concentration for synergy of infections outside the CNS is typically 3 to 4 mcg/mL, many favor higher target peak concentrations for treatment of gram-positive CNS infections to achieve adequate concentrations for synergy in the context of limited cerebrospinal fluid penetration; however, the optimal serum peak concentrations are uncertain. Refer to the UpToDate topic on dosing of parenteral aminoglycosides for further discussion.
Data from:
  • American Academy of Pediatrics. 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.
  • Medications. In: Guidelines for Acute Care of the Neonate, 26th Ed, Fernandes CJ, Pammi M, Katakam L (Eds), Baylor College of Medicine, Houston, TX 2018. p.228.
  • Lexicomp Online. Copyright © 1978-2024 Lexicomp, Inc. All Rights Reserved.
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