| Choice | Antimicrobial | Dosage and Route | Comments and Spectrum of Activity |
|---|---|---|---|
| First-choice antimicrobials (listed in order of potential efficacy) | Cefepime | 150 mg/kg divided q 8 h, IV or IM | Not available in oral form. Activity against gram-positive organisms, except Enterococcus spp. Activity against gram-negative organisms, including Pseudomonas aeruginosa and certain Enterobacteriaceae that generally are resistant to most third-generation cephalosporins. |
| Ceftazidime | 100-300 mg/kg/day divided q 8 h | May need to add amoxicillina or vancomycinb Not available in oral form. Activity against gram-negative organisms, including Pseudomonas aeruginosa and certain Enterobacteriaceae that generally are resistant to most third-generation cephalosporins. |
|
| Ceftriaxone | 50-75 mg/kg/day, IV or IM, once a day | Not available in oral form. Activity against gram-positive organisms, except Enterococcus spp. |
|
| Second-choice | Gentamicin | 3-7.5 mg/kg/day divided q 8-24 h, IV or IM | May need to add amoxicillina or
vancomycinb Not available in oral form. |
| Amikacin | 15-22.5 mg/kg/day divided q 8 h, IV or IM | May need to add amoxicillina or
vancomycinb Not available in oral form. |
|
| Third-choice | Ciprofloxacin | 20-30 mg/kg/day divided q 12 h, PO, IV, or IM | May need to add amoxicillina or
vancomycinb Effective against gram-negative organisms and atypical bacteria. Also effective against Pseudomonas species but poor coverage against gram-positive organisms (including Staphylococcus aureus and nonhemolytic streptococci). |
| Levofloxacin | 10 mg/kg/day, PO, IV, or IM | May need to add amoxicillina or
vancomycinb Effective against gram-negative organisms and atypical bacteria. More gram-positive coverage than ciprofloxacin. |
|
| Gatifloxacin | 10 mg/kg/day, PO or IV | Expanded spectrum against both gram-negative and gram-positive
organisms. Can be administered as single agent. |
a Dosage: 25-50 mg/kg/day divided q
8 h, PO
b Dosage: 40-60 mg/kg/day divided q 6-8
h, IV
Notes: PO = by mouth; IV = intravenous; IM = intramuscular.