Skip to Content

Cefotaxime Dosage

Medically reviewed on April 5, 2017.

Applies to the following strengths: 500 mg; 1 g; 2 g; 10 g; 1 g/50 mL; 2 g/50 mL; 20 g

Usual Adult Dose for Bacteremia

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Use: Treatment of bacteremia or septicemia caused by Escherichia coli, Klebsiella species, Serratia marcescens, Staphylococcus aureus, and Streptococcus species

Usual Adult Dose for Septicemia

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Use: Treatment of bacteremia or septicemia caused by Escherichia coli, Klebsiella species, Serratia marcescens, Staphylococcus aureus, and Streptococcus species

Usual Adult Dose for Sepsis

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Use: Treatment of bacteremia or septicemia caused by Escherichia coli, Klebsiella species, Serratia marcescens, Staphylococcus aureus, and Streptococcus species

Usual Adult Dose for Cesarean Section

1 g IV as soon as the umbilical cord is clamped, then additional 1 g IM or IV doses at 6 and 12 hours after the initial dose

Use: To reduce the incidence of postoperative infections

Usual Adult Dose for Meningitis

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating Klebsiella pneumoniae and E coli have been studied in less than 10 infections.

Use: Treatment of central nervous system infections (including meningitis and ventriculitis) caused by Neisseria meningitides, Haemophilus influenzae, Streptococcus pneumoniae, K pneumoniae, and E coli

Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations: 8 to 12 g per day, given at 4 to 6 hour intervals

Comment: Vancomycin should be added to isolates with a penicillin MIC of 0.12 mcg/mL or higher and a third-generation cephalosporin MIC of 1 mcg/mL or greater.

Uses:
-Treatment of healthcare-associated ventriculitis and meningitis caused by gram-negative bacilli susceptible to third-generation cephalosporins
-Recommended treatment of bacterial meningitis caused by N meningitides, H influenzae, S pneumoniae, and E coli
-Empirical antimicrobial therapy in patients 50 years and younger with purulent meningitis caused by N meningitides or S pneumoniae
-Empirical antimicrobial therapy in patients over 50 years of age with purulent meningitis caused by S pneumoniae, N meningitides, Listeria monocytogenes, or aerobic gram-negative bacilli
-Empirical antimicrobial therapy in patients with basilar skull fractures with purulent meningitis caused by S pneumoniae, H influenzae, Group A beta-hemolytic streptococci

Usual Adult Dose for CNS Infection

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating Klebsiella pneumoniae and E coli have been studied in less than 10 infections.

Use: Treatment of central nervous system infections (including meningitis and ventriculitis) caused by Neisseria meningitides, Haemophilus influenzae, Streptococcus pneumoniae, K pneumoniae, and E coli

Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations: 8 to 12 g per day, given at 4 to 6 hour intervals

Comment: Vancomycin should be added to isolates with a penicillin MIC of 0.12 mcg/mL or higher and a third-generation cephalosporin MIC of 1 mcg/mL or greater.

Uses:
-Treatment of healthcare-associated ventriculitis and meningitis caused by gram-negative bacilli susceptible to third-generation cephalosporins
-Recommended treatment of bacterial meningitis caused by N meningitides, H influenzae, S pneumoniae, and E coli
-Empirical antimicrobial therapy in patients 50 years and younger with purulent meningitis caused by N meningitides or S pneumoniae
-Empirical antimicrobial therapy in patients over 50 years of age with purulent meningitis caused by S pneumoniae, N meningitides, Listeria monocytogenes, or aerobic gram-negative bacilli
-Empirical antimicrobial therapy in patients with basilar skull fractures with purulent meningitis caused by S pneumoniae, H influenzae, Group A beta-hemolytic streptococci

Usual Adult Dose for Pelvic Inflammatory Disease

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:
-Efficacy in treating Enterobacter species, Klebsiella species, Bacteriodes fragilis, and Fusobacterium nucleatum have been studied in less than 10 infections.
-This drug is not active against Chlamydia trachomatis. Patients with pelvic inflammatory disease suspected to be caused by C trachomatis should be given appropriate anti-chlamydial treatment.

Use: Treatment of endometriosis, pelvic inflammatory disease, and pelvic cellulitis caused by Staphylococcus epidermidis, Streptococcus species, Enterococcus species, Enterobacter species, E coli, Klebsiella species, Proteus mirabilis, Bacteroides species, Clostridium species, anaerobic cocci (e.g., Peptostreptococcus species, Peptococcus species), and Fusobacterium species

Usual Adult Dose for Endometritis

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:
-Efficacy in treating Enterobacter species, Klebsiella species, Bacteriodes fragilis, and Fusobacterium nucleatum have been studied in less than 10 infections.
-This drug is not active against Chlamydia trachomatis. Patients with pelvic inflammatory disease suspected to be caused by C trachomatis should be given appropriate anti-chlamydial treatment.

Use: Treatment of endometriosis, pelvic inflammatory disease, and pelvic cellulitis caused by Staphylococcus epidermidis, Streptococcus species, Enterococcus species, Enterobacter species, E coli, Klebsiella species, Proteus mirabilis, Bacteroides species, Clostridium species, anaerobic cocci (e.g., Peptostreptococcus species, Peptococcus species), and Fusobacterium species

Usual Adult Dose for Gonococcal Infection - Uncomplicated

Urethritis/cervicitis: 0.5 g IM once

Rectal gonorrhea:
-Females: 0.5 g IM once
-Males: 1 g IM once

Use: Treatment of uncomplicated cervical/urethral and rectal gonorrhea caused by Neisseria gonorrhoeae, including penicillinase producing strains

US Centers for Disease Control and Prevention (CDC) Recommendations:
Urogenital and anorectal infections: 500 mg IM once

Use: Alternative treatment of uncomplicated gonococcal infections of the cervix, urethra, and rectum

Usual Adult Dose for Intraabdominal Infection

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating Streptococcus species, Peptostreptococcus species, Pseudomonas aeruginosa, P mirabilis, and Clostridium species have been studied in less than 10 infections.

Use: Treatment of intraabdominal infections caused by Streptococcus species, E coli, Klebsiella species, Bacteroides species, anaerobic cocci, P mirabilis, and Clostridium species

IDSA and National Institutes of Health (NIH) Recommendations: 1 g IV every 8 hours

Uses:
-Empiric treatment of bacterial enteric infections for patients with advanced HIV and clinically severe diarrhea (e.g., 6 or more liquid stools/day or bloody stool and/or with fever/chills)
-Treatment of salmonellosis in patients with HIV

Surgical Infection Society (SIS) and IDSA Recommendations: 1 to 2 g IV every 6 to 8 hours PLUS metronidazole

Use: Empirical treatment of community-acquired mild-to-moderate perforated/abscessed appendicitis and other infections of mild-to-moderate severity

Usual Adult Dose for Joint Infection

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating Streptococcus pyogenes, P aeruginosa, and P mirabilis have been studied in less than 10 infections.

Use: Treatment of bone and/or joint infections caused by penicillinase and non-penicillinase producing S aureus, Streptococcus species, Pseudomonas species, and P mirabilis

Usual Adult Dose for Osteomyelitis

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating Streptococcus pyogenes, P aeruginosa, and P mirabilis have been studied in less than 10 infections.

Use: Treatment of bone and/or joint infections caused by penicillinase and non-penicillinase producing S aureus, Streptococcus species, Pseudomonas species, and P mirabilis

Usual Adult Dose for Peritonitis

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating Streptococcus species, Peptostreptococcus species, P aeruginosa, P mirabilis, and Clostridium species have been studied in less than 10 infections.

Use: Treatment of peritonitis caused by Streptococcus species, E coli, Klebsiella species, Bacteroides species, anaerobic cocci, P mirabilis, and Clostridium species

International Society for Peritoneal Dialysis (ISPD) Recommendations:
Intermittent: 500 to 1000 mg intraperitoneally once a day

Use: Empirical treatment of peritonitis suspected to be caused by gram-negative organisms

Usual Adult Dose for Pneumonia

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating S pyogenes and S marcescens have been studied in less than 10 infections.

Use: Treatment of serious lower respiratory tract infections (including pneumonia) caused by S pneumoniae/Diplococcus pneumoniae, S pyogenes (Group A streptococci), other streptococci (except enterococci), penicillinase/non-penicillinase producing S aureus, E coli, Klebsiella species, H influenzae (including ampicillin-resistant organisms), Haemophilus parainfluenzae, P mirabilis, S marcescens, Enterobacter species, and indole positive Proteus and Pseudomonas species

Usual Adult Dose for Skin or Soft Tissue Infection

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating Acinetobacter species, Citrobacter freundii, Proteus vulgaris, Providencia rettgeri, and Peptostreptococcus have been studied in less than 10 infections.

Use: Treatment of skin and structure infections caused by penicillinase and non-penicillinase producing S aureus, Staphylococcus epidermidis, Streptococcus pyogenes (Group A streptococci), other streptococci, Enterococcus species, Acinetobacter species, E coli, Citrobacter species, Enterobacter species, Klebsiella species, P mirabilis, P vulgaris, Morganella morganii, P rettgeri, Pseudomonas species, S marcescens, Bacteroides species, and anaerobic cocci

IDSA Recommendations:
Animal bites: 1 to 2 g IV every 6 to 8 hours
Mixed infections: 2 g IV every 6 hours PLUS metronidazole or clindamycin
Vibrio infections: 2 g IV 3 times a day PLUS doxycycline

Uses:
-Treatment of necrotizing infections of the skin, fascia, and muscle caused by mixed infections or Vibrio vulnificus
-Treatment of infections following animal bites

Usual Adult Dose for Surgical Prophylaxis

1 g IM or IV once

Comments:
-This drug should be given 30 to 90 minutes prior to surgery.
-Some experts recommend preoperative bowel preparation with mechanical cleansing and use of a non-absorbable antibiotic in patients undergoing gastrointestinal procedures.

Use: To reduce the incidence of specific infections in patients undergoing contaminated or possibly contaminated surgical procedures (e.g., abdominal/vaginal hysterectomy, gastrointestinal/genitourinary tract surgery)

American Society of Health-System Pharmacists (ASHP), IDSA, SIS, and Society for Healthcare Epidemiology of America (SHEA) Recommendations:
Non-obese patients: 1 g IV once PLUS ampicillin
Obese patients: 2 g IV once PLUS ampicillin

Comment: The recommended redosing interval is 3 hours.

Use: Surgical antimicrobial prophylaxis in patients undergoing liver transplantation

Usual Adult Dose for Urinary Tract Infection

Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Efficacy in treating S aureus, P vulgaris, M morganii, and P rettgeri have been studied in less than 10 infections.

Use: Treatment of urinary tract infections caused by Enterococcus species, S epidermidis, penicillinase/non-penicillinase producing S aureus, Citrobacter species, Enterobacter species, E coli, Klebsiella species, P mirabilis, P vulgaris, P stuartii, M morganii, P rettgeri, S marcescens, and Pseudomonas species

Usual Adult Dose for Gonococcal Infection - Disseminated

US CDC Recommendations: 1 g IV every 8 hours

Comment: The patient's sexual partner(s) within the past 60 days should be evaluates/treated.

Use: Alternative treatment of arthritis and arthritis-dermatitis syndrome caused by N gonorrhoeae

Usual Adult Dose for Lyme Disease - Neurologic

AAN and IDSA Recommendations: 2 g IV every 8 hours
-Duration of therapy: 14 to 28 days

Use: Treatment of nervous system Lyme disease

Usual Adult Dose for Sinusitis

IDSA Recommendations: 2 g IV every 4 to 6 hours

Uses: Treatment of severe acute bacterial rhinosinusitis requiring hospitalization

Usual Adult Dose for Rhinitis

IDSA Recommendations: 2 g IV every 4 to 6 hours

Uses: Treatment of severe acute bacterial rhinosinusitis requiring hospitalization

Usual Pediatric Dose for Bacteremia

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:
-Uncomplicated infections: 1 g IM or IV every 12 hours
-Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
-Infections needing higher-doses: 2 g IV every 6 to 8 hours
-Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Higher doses should be used to treat more severe/serious infections.

Use: Treatment of bacteremia or septicemia caused by E coli, Klebsiella species, S marcescens, S aureus, and Streptococcus species

IDSA Recommendations:
Neonates 0 to 4 weeks and less than 1200 g: 100 mg/kg IV per day, given in divided doses every 12 hours
Postnatal age 7 days or less and 1200 to 2000 g: 100 mg/kg IV per day, given in divided doses every 12 hours
Postnatal age 7 days or less and greater than 2000 g: 100 to 150 mg/kg IV per day, given in divided doses every 8 to 12 hours
Postnatal age over 7 days and 1200 to 2000 g: 150 mg/kg IV per day, given in divided doses every 8 hours
Postnatal age over 7 days and over 2000 g: 150 to 200 mg/kg IV per day, given in divided doses every 6 to 8 hours
Infants and children 12 years and younger: 100 to 150 mg/kg per day, given in divided doses every 8 hours

Use: Treatment of catheter-related infections

Usual Pediatric Dose for Septicemia

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:
-Uncomplicated infections: 1 g IM or IV every 12 hours
-Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
-Infections needing higher-doses: 2 g IV every 6 to 8 hours
-Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Higher doses should be used to treat more severe/serious infections.

Use: Treatment of bacteremia or septicemia caused by E coli, Klebsiella species, S marcescens, S aureus, and Streptococcus species

IDSA Recommendations:
Neonates 0 to 4 weeks and less than 1200 g: 100 mg/kg IV per day, given in divided doses every 12 hours
Postnatal age 7 days or less and 1200 to 2000 g: 100 mg/kg IV per day, given in divided doses every 12 hours
Postnatal age 7 days or less and greater than 2000 g: 100 to 150 mg/kg IV per day, given in divided doses every 8 to 12 hours
Postnatal age over 7 days and 1200 to 2000 g: 150 mg/kg IV per day, given in divided doses every 8 hours
Postnatal age over 7 days and over 2000 g: 150 to 200 mg/kg IV per day, given in divided doses every 6 to 8 hours
Infants and children 12 years and younger: 100 to 150 mg/kg per day, given in divided doses every 8 hours

Use: Treatment of catheter-related infections

Usual Pediatric Dose for Sepsis

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:
-Uncomplicated infections: 1 g IM or IV every 12 hours
-Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
-Infections needing higher-doses: 2 g IV every 6 to 8 hours
-Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comment: Higher doses should be used to treat more severe/serious infections.

Use: Treatment of bacteremia or septicemia caused by E coli, Klebsiella species, S marcescens, S aureus, and Streptococcus species

IDSA Recommendations:
Neonates 0 to 4 weeks and less than 1200 g: 100 mg/kg IV per day, given in divided doses every 12 hours
Postnatal age 7 days or less and 1200 to 2000 g: 100 mg/kg IV per day, given in divided doses every 12 hours
Postnatal age 7 days or less and greater than 2000 g: 100 to 150 mg/kg IV per day, given in divided doses every 8 to 12 hours
Postnatal age over 7 days and 1200 to 2000 g: 150 mg/kg IV per day, given in divided doses every 8 hours
Postnatal age over 7 days and over 2000 g: 150 to 200 mg/kg IV per day, given in divided doses every 6 to 8 hours
Infants and children 12 years and younger: 100 to 150 mg/kg per day, given in divided doses every 8 hours

Use: Treatment of catheter-related infections

Usual Pediatric Dose for Meningitis

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:
-Uncomplicated infections: 1 g IM or IV every 12 hours
-Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
-Infections needing higher-doses: 2 g IV every 6 to 8 hours
-Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:
-Higher doses should be used to treat more severe/serious infections.
-Efficacy in treating K pneumoniae and E coli have been studied in less than 10 infections.

Use: Treatment of central nervous system infections (including meningitis and ventriculitis) caused by N meningitides, H influenzae, S pneumoniae, K pneumoniae, and E coli

IDSA, AAN, AANS, and NCS Recommendations:
Bacterial meningitis:
0 to 7 days: 100 to 150 mg/kg IV per day, given in divided doses every 8 to 12 hours PLUS ampicillin
8 to 28 days: 150 to 200 mg/kg IV per day, given in divided doses every 6 to 8 hours PLUS ampicillin
Infants and children: 225 to 300 mg/kg IV per day, given in divided doses every 6 to 8 hours PLUS vancomycin

Nosocomial meningitis:
Children: 300 mg/kg IV per day, given at 6 to 8 hour intervals

Comment: Vancomycin should be added to patients over 1 month of age and/or in isolates with a penicillin MIC of 0.12 mcg/mL or higher and a third-generation cephalosporin MIC of 1 mcg/mL or greater.

Uses:
-Empirical antimicrobial therapy in patients less than 1 month of age with purulent meningitis caused by S agalactiae, E coli, L monocytogenes, or Klebsiella species
-Empirical antimicrobial therapy in patients 1 to 23 months of age with purulent meningitis caused by S pneumoniae, N meningitides, S agalactiae, H influenzae, or E coli
-Empirical antimicrobial therapy in patients 2 years and older with purulent meningitis caused by N meningitides or S pneumoniae
-Empirical antimicrobial therapy in patients with basilar skull fractures with purulent meningitis caused by S pneumoniae, H influenzae, Group A beta-hemolytic streptococci

Usual Pediatric Dose for CNS Infection

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:
-Uncomplicated infections: 1 g IM or IV every 12 hours
-Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
-Infections needing higher-doses: 2 g IV every 6 to 8 hours
-Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:
-Higher doses should be used to treat more severe/serious infections.
-Efficacy in treating K pneumoniae and E coli have been studied in less than 10 infections.

Use: Treatment of central nervous system infections (including meningitis and ventriculitis) caused by N meningitides, H influenzae, S pneumoniae, K pneumoniae, and E coli

IDSA, AAN, AANS, and NCS Recommendations:
Bacterial meningitis:
0 to 7 days: 100 to 150 mg/kg IV per day, given in divided doses every 8 to 12 hours PLUS ampicillin
8 to 28 days: 150 to 200 mg/kg IV per day, given in divided doses every 6 to 8 hours PLUS ampicillin
Infants and children: 225 to 300 mg/kg IV per day, given in divided doses every 6 to 8 hours PLUS vancomycin

Nosocomial meningitis:
Children: 300 mg/kg IV per day, given at 6 to 8 hour intervals

Comment: Vancomycin should be added to patients over 1 month of age and/or in isolates with a penicillin MIC of 0.12 mcg/mL or higher and a third-generation cephalosporin MIC of 1 mcg/mL or greater.

Uses:
-Empirical antimicrobial therapy in patients less than 1 month of age with purulent meningitis caused by S agalactiae, E coli, L monocytogenes, or Klebsiella species
-Empirical antimicrobial therapy in patients 1 to 23 months of age with purulent meningitis caused by S pneumoniae, N meningitides, S agalactiae, H influenzae, or E coli
-Empirical antimicrobial therapy in patients 2 years and older with purulent meningitis caused by N meningitides or S pneumoniae
-Empirical antimicrobial therapy in patients with basilar skull fractures with purulent meningitis caused by S pneumoniae, H influenzae, Group A beta-hemolytic streptococci

Usual Pediatric Dose for Intraabdominal Infection

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:
-Uncomplicated infections: 1 g IM or IV every 12 hours
-Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
-Infections needing higher-doses: 2 g IV every 6 to 8 hours
-Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:
-Higher doses should be used to treat more severe/serious infections.
-Efficacy in treating Streptococcus species, Peptostreptococcus species, P aeruginosa, P mirabilis, and Clostridium species have been studied in less than 10 infections.

Use: Treatment of peritonitis caused by Streptococcus species, E coli, Klebsiella species, Bacteroides species, anaerobic cocci, P mirabilis, and Clostridium species

IDSA and NIH Recommendations:
Adolescents: 1 g IV every 8 hours

Uses:
-Empiric treatment of bacterial enteric infections for patients with advanced HIV and clinically severe diarrhea (e.g., 6 or more liquid stools/day or bloody stool and/or with fever/chills)
-Treatment of salmonellosis in patients with HIV

Surgical Infection Society (SIS) and Infectious Diseases Society of America (IDSA) Recommendations: 150 to 200 mg/kg IV per day, given in divided doses every 6 to 8 hours

Use: Empirical treatment of community-acquired infections

Usual Pediatric Dose for Joint Infection

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:
-Uncomplicated infections: 1 g IM or IV every 12 hours
-Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
-Infections needing higher-doses: 2 g IV every 6 to 8 hours
-Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:
-Higher doses should be used to treat more severe/serious infections.
-Efficacy in treating S pyogenes, P aeruginosa, and P mirabilis have been studied in less than 10 infections.

Use: Treatment of bone and/or joint infections caused by penicillinase and non-penicillinase producing S aureus, Streptococcus species, Pseudomonas species, and P mirabilis

Usual Pediatric Dose for Osteomyelitis

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:
-Uncomplicated infections: 1 g IM or IV every 12 hours
-Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
-Infections needing higher-doses: 2 g IV every 6 to 8 hours
-Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:
-Higher doses should be used to treat more severe/serious infections.
-Efficacy in treating S pyogenes, P aeruginosa, and P mirabilis have been studied in less than 10 infections.

Use: Treatment of bone and/or joint infections caused by penicillinase and non-penicillinase producing S aureus, Streptococcus species, Pseudomonas species, and P mirabilis

Usual Pediatric Dose for Peritonitis

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:
-Uncomplicated infections: 1 g IM or IV every 12 hours
-Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
-Infections needing higher-doses: 2 g IV every 6 to 8 hours
-Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:
-Higher doses should be used to treat more severe/serious infections.
-Efficacy in treating Streptococcus species, Peptostreptococcus species, P aeruginosa, P mirabilis, and Clostridium species have been studied in less than 10 infections.

Use: Treatment of peritonitis caused by Streptococcus species, E coli, Klebsiella species, Bacteroides species, anaerobic cocci, P mirabilis, and Clostridium species

ISPD Recommendations:
Continuous peritoneal dialysis:
-Loading dose: 500 mg/L intraperitoneally once
-Maintenance dose: 250 mg/L intraperitoneally

Intermittent peritoneal dialysis: 30 mg/kg intraperitoneally once a day
-Duration of therapy: 2 weeks

Comments:
-Patients receiving continuous dialysis should allow the loading dose to dwell for 3 to 6 hours.
-Patients receiving intermittent dialysis should be given the dose once a day in the long dwell.

Use: Treatment of peritonitis caused by E coli or Klebsiella species

Usual Pediatric Dose for Pneumonia

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:
-Uncomplicated infections: 1 g IM or IV every 12 hours
-Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
-Infections needing higher-doses: 2 g IV every 6 to 8 hours
-Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:
-Higher doses should be used to treat more severe/serious infections.
-Efficacy in treating S pyogenes and S marcescens have been studied in less than 10 infections.

Use: Treatment of serious lower respiratory tract infections (including pneumonia) caused by S pneumoniae/D pneumoniae, S pyogenes (Group A streptococci), other streptococci (except enterococci), penicillinase/non-penicillinase producing S aureus, E coli, Klebsiella species, H influenzae (including ampicillin-resistant organisms), H parainfluenzae, P mirabilis, S marcescens, Enterobacter species, and indole positive Proteus and Pseudomonas species

IDSA and NIH Recommendations:
Children: 40 to 50 mg/kg IV 4 times a day OR 50 to 65 mg/kg IV 3 times a day
-Maximum dose: 8 to 10 g/day

Use: Treatment of bacterial pneumonia caused by S pneumoniae, S aureus, H influenzae, or P aeruginosa in patients exposed to or with HIV

Pediatric Infectious Diseases Society (PIDS) and IDSA Recommendations:
Older than 3 months: 150 mg/kg IV per day, given in divided doses every 8 hours

Uses:
-Preferred treatment of community-acquired pneumonia caused by H influenzae types A to
F or non-typeable
-Alternative treatment of community-acquired pneumonia caused by Group A Streptococcus or S pneumoniae with penicillin MICs of 2 mcg/mL or less

Usual Pediatric Dose for Skin or Soft Tissue Infection

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:
-Uncomplicated infections: 1 g IM or IV every 12 hours
-Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
-Infections needing higher-doses: 2 g IV every 6 to 8 hours
-Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:
-Higher doses should be used to treat more severe/serious infections.
-Efficacy in treating Acinetobacter species, C freundii, P vulgaris, P rettgeri, and Peptostreptococcus have been studied in less than 10 infections.

Use: Treatment of skin and structure infections caused by penicillinase and non-penicillinase producing S aureus, S epidermidis, S pyogenes (Group A streptococci), other streptococci, Enterococcus species, Acinetobacter species, E coli, Citrobacter species, Enterobacter species, Klebsiella species, P mirabilis, P vulgaris, M morganii, P rettgeri, Pseudomonas species, S marcescens, Bacteroides species, and anaerobic cocci

IDSA Recommendations:
Children: 50 mg/kg IV per day, given in divided doses every 6 hours PLUS metronidazole or clindamycin

Use: Treatment of necrotizing infections of the skin, fascia, and muscle caused by mixed infections

Usual Pediatric Dose for Urinary Tract Infection

0 to 1 week: 50 mg/kg IV every 12 hours
1 to 4 weeks: 50 mg/kg IV every 8 hours

1 month to 12 years:
Less than 50 kg: 50 to 180 mg/kg IM or IV per day, given in 4 to 6 equal doses
50 kg or more:
-Uncomplicated infections: 1 g IM or IV every 12 hours
-Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
-Infections needing higher-doses: 2 g IV every 6 to 8 hours
-Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

12 years and older:
Uncomplicated infections: 1 g IM or IV every 12 hours
Moderate to severe infections: 1 to 2 g IM or IV every 8 hours
Infections needing higher-doses: 2 g IV every 6 to 8 hours
Life-threatening infections: 2 g IV every 4 hours
Maximum dose: 12 g/day

Comments:
-Higher doses should be used to treat more severe/serious infections.
-Efficacy in treating S aureus, P vulgaris, M morganii, and P rettgeri have been studied in less than 10 infections.

Use: Treatment of urinary tract infections caused by Enterococcus species, S epidermidis, penicillinase/non-penicillinase producing S aureus, Citrobacter species, Enterobacter species, E coli, Klebsiella species, P mirabilis, P vulgaris, P stuartii, M morganii, P rettgeri, S marcescens, and Pseudomonas species

Usual Pediatric Dose for Surgical Prophylaxis

ASHP, IDSA, SIS, and SHEA Recommendations:
Pediatric patients: 50 mg/kg IV once PLUS ampicillin
-Maximum dose: 1 g/dose

Comment: The recommended redosing interval is 3 hours.

Use: Surgical antimicrobial prophylaxis in patients undergoing liver transplantation

Usual Pediatric Dose for Gonococcal Infection - Uncomplicated

US CDC Recommendations:
Adolescents:
Urogenital and anorectal infections: 500 mg IM once

Use: Alternative treatment of uncomplicated gonococcal infections of the cervix, urethra, and rectum

Usual Pediatric Dose for Gonococcal Infection - Disseminated

US CDC Recommendations:
Neonates: 25 mg/kg IM or IV every 12 hours
Duration of therapy:
-Disseminated gonococcal infection (DGI): 7 days
-DGI with meningitis: 10 to 14 days

Adolescents: 1 g IV every 8 hours

Comments:
-The patient's sexual partner(s) within the past 60 days should be evaluates/treated.
-Treatment should be used with caution in infants with hyperbilirubinemia.

Uses:
-Treatment of DGI and gonococcal scalp abscesses
-Alternative treatment of arthritis and arthritis-dermatitis syndrome caused by N gonorrhoeae

Usual Pediatric Dose for Lyme Disease - Neurologic

AAN and IDSA Recommendations:
Pediatric patients: 150 to 200 mg/kg IV per day, given in 3 to 4 divided doses
-Maximum dose: 6 g/day
-Duration of therapy: 14 to 28 days

Use: Treatment of nervous system Lyme disease

Usual Pediatric Dose for Sinusitis

IDSA Recommendations:
Children: 100 to 200 mg/kg IV per day, given in divided doses every 6 hours

Use: Treatment of severe acute bacterial rhinosinusitis requiring hospitalization

Usual Pediatric Dose for Rhinitis

IDSA Recommendations:
Children: 100 to 200 mg/kg IV per day, given in divided doses every 6 hours

Use: Treatment of severe acute bacterial rhinosinusitis requiring hospitalization

Renal Dose Adjustments

CrCl 20 to 90 mL/min: Dose adjustment(s) may be required; however, no specific guidelines have been suggested. Caution recommended.
CrCl less than 20 mL/min: The dose should be reduced by 50% of the normal dose.
Duration of therapy: At least 10 days (Infections caused by Group A beta-hemolytic streptococci)

Comments:
-Treatment should continue for at least 48 to 72 hours after the patient's condition improves and/or evidence of bacterial eradication occurs.
-Patients with persistent infections may require weeks of treatment, but should not receive doses lower than indicated.

Liver Dose Adjustments

Data not available

Dose Adjustments

Abnormal blood counts during treatment: Consider discontinuation of this drug.

Precautions

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-IM: This drug should be injected deep into the body of a large muscle. Providers should aspirate the solution to ensure that treatment did not enter blood vessels. Doses up to 2 g may be given if divided and administered into different areas of the body.
-Intermittent IV: This drug should be injected over at least 3 to 5 minutes.

Storage requirements:
-Premixed injection solution: Store in the freezer until ready to use. Once thawed, this drug is stable for 10 days (5C or below) or 24 hours (22C or below); the solution should not be refrozen.
-Powder for reconstitution: Once reconstituted in original containers or disposable plastic syringes, this drug is stable for up to 13 weeks (frozen), 5 days (at 5C or below), or 24 hours (at 22C or below

IV compatibility:
-This drug should not be admixed with aminoglycoside antibiotics.

General:
-Limitation of use: This drug is not active against Chlamydia trachomatis.
-IV administration is preferred in patients with severe or life-threatening infections (e.g., bacteremia, septicemia, peritonitis, meningitis) or those with lower resistance due to debilitating conditions (e.g., malnutrition, trauma, surgery, diabetes, heart failure, malignancy [especially with present/impending shock]).
-Spectrum of Activity: Susceptibility varies geographically and may change over time; local susceptibility data should be consulted, if available. This drug has shown activity in vitro and in clinical infections against most isolates of Enterococcus species (may be intrinsically resistant), S aureus (methicillin-susceptible isolates only), S epidermidis, S pneumoniae, S pyogenes, viridans group streptococci, Acinetobacter species, Citrobacter species, Enterobacter species, E coli, H influenzae, H parainfluenzae, Klebsiella species, M morganii, N gonorrhoeae, N meningitidis, Proteus mirabilis, P vulgaris, P rettgeri, P stuartii, S marcescens, Bacteroides species, Clostridium species (most Clostridium difficile isolates are resistant), Fusobacterium species, Peptococcus species, and Peptostreptococcus species; most extended spectrum beta-lactamase-producing and carbapenemase-producing isolates are resistant. This drug has shown in vitro activity against Providencia species, Salmonella species, and Shigella species; however, efficacy has not been established in treating clinical infections.

Monitoring:
-Hematologic: White blood cell counts, especially in patients receiving treatment for longer than 7 days
-Hepatic: Hepatic function tests, especially in patients with hepatic dysfunction or with decreased hepatic blood flow
-Renal: Renal function tests, especially in patients with renal dysfunction or when given with aminoglycoside antibiotics

Patient advice:
-Patients should be told to report any unusual or severe side effects.
-Patients should be instructed to report signs/symptoms of C difficile infection (e.g., watery/bloody stools, stomach cramps, fever), for up to 2 months after stopping treatment.
-Patients should be directed to take the full course of treatment, even if they feel better.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Hide