Dosage of Some Useful Drugs

A.

Aciclovir Neonate–12 wks.: 20 mg/kg i.v. over 1 h daily (<30 wks. gest), 18 H (30–32 wks.),12 H (1st wks. life), 8 H (2–12 wks.) for 2 wks. (3 wks. and CSF PCR –ve if herpes encephalitis). >12 wks.: EBV, herpes encephalitis, immunodeficiency, varicella: 500 mg/m2 (12 wks.–12 yr) 10 mg/kg (>12 yr) 8 H i.v. over 1 h. Cutaneous herpes 250 mg/m2 (12 wks.–12 yrs.) 5 mg/kg (>12 yrs.) 8 H i.v. over 1 h. Genital herpes (>12 yr NOT /kg): 200 mg oral ×5/day for 10 days, then 200 mg ×2–3/day for 6 mo if reqd. Zoster (>12 yr NOT /kg): 400 mg (<2 yr) or 800 mg (≥ 2 yr) oral ×5/day for 7 days. Cold sores: 5% cream ×5/day. Eye: 3% ointment ×5/day.

Adenosine Arrhythmia: 0.1 mg/kg (adult 3 mg) stat by rapid i.v. push, incr by 0.1 mg/kg(adult 3 mg) every 2 min to max. 0.5 mg/kg (adult 18 mg). Pul hypertension: 50 mcg/kgper min (3 mg/mL at 1 mL/kg per hour) into central vein.

Adrenaline Croup: 1% 0.05 mL/kg diluted to 4 mL by inhaltn; or 1/1000 0.5 mL/kg(max. 6 mL) by inhalation. Cardiac arrest (repeat if reqd): 0.1 mL/kg of 1/10 000 i.v. or intracardiac;via ETT 0.1 mL/kg of 1/1000. Anaphylaxis: 0.05–0.1 mL/kg of 1/10 000 i.v., repeat if reqd. I.m. into thigh: 0.01 mg/kg (0.01 mL/kg of 1/1000) up to 0.1 mg/kg, ×3 doses 20 min apart if reqd. I.v. infsn 0.3 mg/kg in 50 mL 5%dex–hep at 0.5–10 mL/h (0.05–1 mcg/kg per min).

Alprostadil (prostaglandin E1, PGE1) To maintain PDA: 60 mcg/kg in 50 mL 0.9% saline 0.5–3 mL/h (10–60 ng/kg per min). Erectile dysfunction (adult NOT /kg): 2.5 mcg intracavernous inj, incr in 2.5 mcg increments if reqrd to max. 60 mcg (max. of 3 doses/wk).

Alteplase (tissue plasminogen activator) 0.1–0.6 mg/kg per hour i.v. for 6–12 h(longer if no response); keep fi brinogen >100 mg/dL (give cryoprecipitate 1 bag/5 kg), give heparin 10 u/kg per hour i.v., give fresh frozen plasma (FFP) 10 mL/kg i.v. daily in infants. Local IA infsn: 0.05 mg/kg per hour, give FFP 10 mL/kg i.v. daily. Blocked central line: 0.5 mg/2 mL (<10 kg) 2 mg/2 mL (>10 kg) per lumen left for 2–4 h, withdraw drug, fl ush with saline; repeat once in 24 h if reqd.

Amikacin Single daily dose i.v. or i.m. Neonate: 15 mg/kg stat, then 7.5 mg/kg (<30 wk)10 mg/kg (30–35 wk) 15 mg/kg (term <1 wk) daily. 1 wk–10 yr: 25 mg/kg day 1, then 18 mg/kg daily. >10 yr: 20 mg/kg day 1, then 15 mg/kg (max. 1.5 g) daily. Trough level <5.0 mg/L (RCH sent to St.V’s).

Aminocaproic acid 3 g/m2 (adult 5 g) over 1 h i.v., then 1 g/m2/h (adult 1–1.25 g/h). Prophylaxis: 70 mg/kg 6 H i.v., oral.

Aminophylline (100 mg aminophylline, 80 mg theophylline) Load: 10 mg/kg (max. 500 mg) i.v. over 1 h. Maintenance: 1st wk life 2.5 mg/kg i.v. over 1 h 12 H; 2nd wk life 3 mg/kg 12 H; 3 wk–12 mo ((0.12 × age in wk) + 3) mg/kg 8 H; <35 kg and >12 mo, 55 mg/kg in 50 mL 5%dex-hep at 1 mL/h (1.1 mg/kg per hour) or 6 mg/kg i.v. over 1 h 6 H; >35 kg and <17 yr, or >17 yr and smoker, 25 mg/mL at 0.028 mL/kg per hour (0.7 mg/kg per hour) or 4 mg/kg i.v. over 1 h 6 H; >17 yr non-smoker 25 mg/mL at 0.02 mL/kg per hour (0.5 mg/kg per hour) or 3 mg/kg i.v. over 1 h 6 H. Level 60–80 μmol/L (neonate), 60–110 (asthma) (×0.18 = mcg/mL).

Amiodarone I.v.: 15 mg/kg in 50 mL 5%dex (no heparin) at 5 mL/h (25 mcg/kg per min) for 4 h, then 1–3 mL/h (5–15 mcg/kg per min, max. 1.2 g/24 h). Oral: 4 mg/kg (adult 200 mg) 8 H 1 wk, 12 H 1 wk, then 12–24 H. After starting tablets, taper i.v. infsn over 5 days. Reduce dose of digoxin and warfarin. Pulseless VF or VT: 5 mg/kg i.v. over 3–5 min.

Amoxycillin (amoxicillin) 10–25 mg/kg (adult 0.25–1 g) 8 H i.v., i.m. or oral; or 20 mg/kg 12 H oral. Severe inftn: 50 mg/kg (adult 2 g) i.v. 12 H (1st wk life), 6 H (2–4 wk), 4–6 H or constant infsn (4+ wk).

Amoxycillin (amoxicillin) and clavulanic acid Dose as for amoxicillin. 4: 1 (non-Duo products) gave 8 H, 7: 1 (Duo) 12 H, 16: 1 (XR) 12 H oral.

Amphotericin B (Fungizone) Usually 1.5 mg/kg per day (up to 2 mg/kg per day) by continuous infsn i.v. Central line: 1.5 mg/kg in 50 mL 5%dex-hep at 2 mL/h (≤46 kg); 1.5 mg/kg in 1.2 mL/kg 5%dex-hep (1.25 mg/mL) at 0.05 mL/kg per hour (>46 kg). Peripheral i.v.: usually 1.5 mg/kg in 12 mL/kg 5% dex-hep at 0.5 mL/kg per hour (higher concentrations may cause thrombophlebitis). Oral (NOT /kg): 100 mg 6 H treatment, 50 mg 6 H prophylaxis. Bladder washout: 25 mcg/mL. Cream or ointment 3%: apply 6–12 H.

Ampicillin 10–25 mg/kg (adult 0.25–1 g) 6 H i.v., i.m. or oral. Severe inftn: 50 mg/kg (max. 2 g) i.v. 12 H (1st wk life), 6 H (2–4 wk), 3–6 H or constant infsn (4+ wk).

Ampicillin 1 g + sulbactam 0.5 g 25–50 mg/kg (adult 1–2 g) of ampicillin 6 H i.m. or i.v. over 30 min.

Aspirin 10–15 mg/kg (adult 300–600 mg) 4–6 H oral. Antiplatelet: 3–5 mg/kg (max. 100 mg) daily. Kawasaki: 10 mg/kg 6 H (low dose) or 25 mg/kg 6 H (high dose) for 2 wk, then 3–5 mg/kg daily. Arthritis: 25 mg/kg (max. 2 g) 6 H for 3 days, then 15–20 mg/kg 6 H. Salicylate level (arthritis) midway between doses 0.7–2.0 mmol/L (×13.81 = mg/100 mL).

Aspirin 25 mg + dipyridamole 200 mg Adult (NOT /kg) 1 sustained release cap 12 H oral.

Atenolol Oral: 1–2 mg/kg (adult 50–100 mg) 12–24 H. I.v.: 0.05 mg/kg (adult 2.5 mg) every 5 min if reqd (max. 4 doses), then 0.1–0.2 mg/kg (adult 5–10 mg) over 10 min12–24 H.

Atropine sulfate 0.02 mg/kg (max. 0.6 mg) i.v. or i.m., then 0.01 mg/kg 4–6 H. Organophosphate poisoning: 0.05–1 mg/kg (adult 2 mg) i.v., then 0.02–0.05 mg/kg (adult 2 mg) every 15–60 min until atropinised, then 0.02–0.08 mg/kg per hour may be needed for many days. Colic: see phenobarbitone.

B.

Bicarbonate Slow i.v.: dose (mmol) = BE × wt/4 (<5 kg), BE × wt/6 (child), BE × wt/10 (adult). These doses correct 1/2 the base defi cit. Alkalinise urine: 0.25 mmol/kg 6–12 H oral.

C.

Calcium (as carbonate, lactate or phosphate) NOT /kg: Neonate: 50 mg ×4–6/day; 1 mo-3 yr: 100 mg ×2–5/day oral; 4–12 yr: 300 mg ×2–3/day; >12 yr: 1000 mg ×1–2/day.

Calcium carbonate Adult NOT /kg: 840 mg 8–12 H oral.

Calcium chloride 10% soltn (0.7 mmol/mL Ca): 0.2 mL/kg (max. 10 mL) slow i.v. stat. Requirement <16 yr 2 mL/kg per day i.v. Inotrope: 0.03–0.12 mL/kg per hour (0.5–2 mmol/kg per day) undiluted via CVC.

Calcium gluconate 10% soltn (0.22 mmol/mL Ca): 0.5 mL/kg (max. 20 mL) slow i.v. stat. Requirement <16 yr 5 mL/kg per day i.v. Inotrope: 0.5–2 mmol/kg per day (0.1–0.4 mL/kg per hour) undiluted via CVC.

Captopril Beware hypotension. 0.1 mg/kg (adult 2.5–5 mg) 8 H oral, incr if reqd to max. 2 mg/kg (adult 50 mg) 8 H. Less hypotension if mixed with NG feeds given continuously (or 1–2 hrly).

Ceftibuten 10 mg/kg (adult 400 mg) daily oral.

Ceftriaxone sodium 25 mg/kg (adult 1 g) 12–24 H i.v., or i.m. (in 1% lignocaine [lidocaine]). Severe inftn: 50 mg/kg (max. 2 g) daily (1st wk life), 12 H (2+ wk). Epiglottitis: 100 mg/kg (max. 2 g) stat, then 50 mg/kg (max. 2 g) after 24 h. Meningococcus prophylaxis (NOT /kg): child 125 mg, >12 yr 250 mg i.m. in 1% lignocaine [lidocaine] once.

Cefuroxime Oral (as cefuroxime axetil): 10–15 mg/kg (adult 250–500 mg) 12 H. i.v.: 25 mg/kg (adult 1 g) 8 H. Severe inftn: 50 mg/kg (max. 2 g) i.v. 12 H (1st wk life), 8 H (2nd wk), 6 H or constant infsn (>2 wk).

Cetirizine NOT /kg: 2.5 mg (6 mo-2 yr), 2.5–5 mg (2–5 yr), 5–10 mg (>5 yr) daily oral.

Chlorothiazide 5–20 mg/kg (adult 0.25–1 g) 12–24 H oral, i.v.

Ciprofl oxacin 5–10 mg/kg (adult 250–500 mg) 12 H oral, 4–7 mg/kg (adult 200– 300 mg) 12 H i.v. Severe inftn, or cystic fi brosis: 20 mg/kg (max. 750 mg) 12 H oral, 10 mg/kg (max. 400 mg) 8 H i.v.; higher doses used occasionally. Meningococcus proph: 15 mg/kg (max. 500 mg) once oral. Reduce dose of theophylline.

Clarithromycin 7.5–15 mg/kg (adult 250–500 mg) 12 H oral. Slow release tab, adult (NOT /kg): 0.5 g or 1 g daily.

Clindamycin 6 mg/kg (adult 150–450 mg) 6 H oral. I.v. or i.m. >28 days: 10 mg/kg (adult 600 mg) 8 H (i.v. over 30 min). Neonate: 5 mg/kg 12 H (preterm <1 wk old), 5 mg/kg 8 H (preterm >1 wk, term <1 wk), 7.5 mg/kg 8 H (term >1 wk) i.v. over 30 min. Severe inftn (>28 days): 15–20 mg/kg (adult 900 mg) 8 H i.v. over 1 h. Acne soltn 1%: apply 12 H.

Co-trimoxazole (trimethoprim 1 mg + sulfamethoxazole 5 mg) TMP 1.5–3 mg/kg (adult 80–160 mg) 12 H i.v. over 1 h or oral. Renal proph: TMP 2 mg/kg (max. 80 mg) daily oral. Pneumocystis proph: TMP 5 mg/kg daily on 3 days/wk. Pneumocystis treat: TMP 250 mg/m2 stat, then 150 mg/m2 8 H (<11 yr) or 12 H (>10 yr) i.v. over 1 h; in renal failure dose interval (h) = serum creatinine (mmol/l) × 135 (max. 48 h); 1 h post-infsn serum TMP 5–10 mcg/mL, SMX 100–200 mcg/mL. i.v. infsn: TMP max. 1.6 mg/mL in 5% dextrose.

D.

Dexamethasone 0.1–0.25 mg/kg 6 H oral, i.m. or i.v. BPD: 0.1 mg/kg 6 H for 3 days, then 8 H 3 days, 12 H 3 days, 24 H 3 days, 48 H 7 days. Cerebral oedema: 0.25–1 mg/kg (adult 10–50 mg) stat, then 0.1–0.2 mg/kg (adult 4–8 mg) 4 H i.v. reducing over 3–5 days to 0.05 mg/kg (adult 2 mg) 8–12 H. Congen adr hypopl: 0.27 mg/m2 daily oral. Severe croup, extubtn stridor: 0.6 mg/kg (max. 12 mg) i.v. or i.m. stat, then prednisolone 1 mg/kg 8–12 H oral. Eye drops 0.1%: 1–2 drops per eye 3–8 H. Dexamethasone has no mineralocorticoid action; 1 mg = 25 mg hydrocortisone in glucocorticoid action.

Diazepam 0.1–0.4 mg/kg (adult 10–20 mg) i.v. or PR. 0.04–0.2 mg/kg (adult 2–10 mg) 8–12 H oral. Do not give by i.v. infsn (binds to PVC). Premed: 0.2–0.4 mg/kg oral, PR.

Diazoxide Hypertension: 1–3 mg/kg (max. 150 mg) stat by rapid i.v. injection (severe hypotension may occur) repeat once if reqd, then 2–5 mg/kg i.v. 6 H. Hyperinsulinism: <12 mo 5 mg/kg 8–12 H oral; >12 mo 30–100 mg/m2 per dose 8 H oral.

Digoxin 15 mcg/kg stat and 5 mcg/kg after 6 H, then 3–5 mcg/kg (usual max. 200 mcg i.v., 250 mcg oral) 12 H slow i.v. or oral. Level 6 h or more after dose: 1.0–2.5 nmol/L (×0.78 = ng/mL), done Mo–Sat 1400 at RCH.

Digoxin immune FAB (antibodies) I.v. over 30 min. Dose (to nearest 40 mg) = serum digoxin (nmol/L) × wt (kg) × 0.3, or mg ingested × 55. Give if >0.3 mg/kg ingested, or level >6.4 nmol/L or 5.0 ng/mL.

Dobutamine <30 kg: 15 mg/kg in 50 mL 0.9% saline with heparin 1 u/mL at 1–4 mL/h (5–20 mcg/kg per min) via CVC or periph i.v.; >30 kg: 6 mg/kg made up to 100 mL with 0.9% saline with heparin 1 u/mL at 5–20 mL/h (5–20 mcg/kg per hour).

Domperidone Oral: 0.2–0.4 mg/kg (adult 10–20 mg) 4–8 H. Rectal suppos: adult (NOT /kg) 30–60 mg 4–8 H.

Dopamine <30 kg: 15 mg/kg in 50 mL 5%dex-hep at 1–4 mL/h (5–20 mcg/kg per min) via CVC; >30 kg: 6 mg/kg made up to 100 mL in 5%dex-hep at 5–20 mL/h (5–20 mcg/kg per hour).

Doxapram 5 mg/kg i.v. over 1 h, then 0.5–1 mg/kg per hour for 1 h (max. total dose 400 mg).

E.

Enalapril 0.1 mg/kg (adult 2.5 mg) daily oral, incr over 2 wk if reqd to max. 0.5 mg/kg (adult 5–20 mg) 12 H.

F.

Fentanyl Not ventltd: 1–2 mcg/kg (adult 50–100 mcg) i.m. or i.v.; infsn 2–4 mcg/kg per hour (<10 kg 100 mcg/kg in 50 mL 5%dex-hep at 1–2 mL/h; >10 kg amp 50 mcg/mL at0.04–0.08 mL/kg per hour). Ventltd: 5–10 mcg/kg stat or 50 mcg/kg i.v. over 1 h; infuseamp 50 mcg/mL at 0.1–0.2 mL/kg per hour (5–10 mcg/kg per hour). Patch (lasts 72 h) in adult (NOT /kg): 25 mcg/h, incr if reqd by 25 mcg/h every 3 days. Epidural: 0.5 mcg/kg stat, or 0.4 mcg/kg per hour.

Flucloxacillin Oral: 12.5–25 mg/kg (adult 250–500 mg) 6 H. i.m. or i.v.: 25 mg/kg (adult 1 g) 6 H. Severe inftn: 50 mg/kg (adult 2 g) i.v. 12 H (1st wk life), 8 H (2–4 wk), 6 H or constant infsn (>4 wk).

Fluconazole 6 mg/kg (adult 200 mg) stat, then 3 mg/kg (adult 100 mg) daily oral or i.v. Severe inftn: 12 mg/kg (adult 400 mg) stat, then 6–12 mg/kg (adult 200–400 mg) daily i.v.; if haemofi ltered 12 mg/kg (adult 600 mg) 12 H.

Frusemide (furosemide) usually 0.5–1 mg/kg (adult 20–40 mg) 6–24 H (daily if preterm) oral, i.m., or i.v. over 20 min (max. 0.05 mg/kg per min i.v.). I.v. infsn: 0.1–1 mg/kg per hour (<20 kg 25 mg/kg in 50 mL 0.9% saline with heparin 1 u/mL at 0.2–2 mL/h;>20 kg amp 10 mg/mL at 0.01–0.1 mL/kg per hour); protect from light.

G.

Ganciclovir 5 mg/kg 12 H i.v. over 1 h for 2–3 wk; then 5 mg/kg i.v. daily, or 6 mg/kg i.v. on 6 days every wk, or 20 mg/kg (adult 1 g) 8 H oral. Congenital CMV: 7.5 mg/kg 12 H i.v. over 2 h.

Gentamicin I.v. or i.m. 1 wk–10 yr: 8 mg/kg day 1, then 6 mg/kg daily. >10 yr: 7 mg/kg day 1, then 5 mg/kg (max. 240–360 mg) daily. Neonate, 5 mg/kg dose: <1200 g 48 H (0–7 days of life), 36 H (8–30 days), 24 H (>30 days); 1200–2500 g 36 H (0–7 days of life), 24 H (>7 days); term 24 H (0–7 days of life), then as for 1 wk–10 yr. Trough level <1.0 mg/L.

H.

Hydralazine 0.1–0.2 mg/kg (adult 5–10 mg) stat i.v. or i.m., then 4–6 mcg/kg per min (adult 200–300 mcg/min) i.v. Oral: 0.4 mg/kg (adult 20 mg) 12 H, slow incr to 1.5 mg/kg (usual max. 50 mg) 6–8 H.

Hydrochlorothiazide 1–1.5 mg/kg (adult 25–50 mg) 12–24 H oral.

Hydrochlorothiazide + quinapril 10/12.5, 20/12.5 Adult (NOT /kg): 10/12.5 tab daily oral, incr if reqd to 20/12.5 tab, max. two 10/12.5 tab daily.

Hydrocortisone Usually 0.5–2 mg/kg (adult 25–50 mg) 6–8 H oral, reducing as tolerated. 0.5%, 1% cream, ointment: apply 6–12 H. 1% cream + clioquinol: apply 8–24 H. 10% rectal foam: 125 mg/dose.

I.

Insulin Regular insulin i.v.: 0.05–0.2 u/kg prn, or 0.025–0.1 u/kg per hour (2.5 u/kg in 50 mL 4% albumin at 0.5–2 mL/h); later 1 u/10 g dextrose. For hyperkalaemia: 0.1 u/kg insulin and 2 mL/kg 50% dextrose i.v. In TPN: 5–25 u/250 g dextrose. s.c. insulin (onset/peak/ duration): lispro 10–15 min/1 h/2–5 h; aspart 15–20 min/1 h/3–5 h; regular 30–60 min/4 h/6–8 h; isophane (NPH) 2–4 h/4–12 h/18–24 h; zinc (Lente) 2–3 h/7– 15 h/24 h; glargine 1.5 h/none/24 h; crystalline zinc (Ultralente) 4–6 h/10–30 h/24–36 h; protamine zinc 4–8 h/15–20 h/24–36 h.

K.

Ketamine Sedation, analgesia: 2–4 mg/kg i.m., 4 mcg/kg per min i.v. Premed: 5 mg/kg oral. Anaesthesia: 5–10 mg/kg i.m., 1–2 mg/kg i.v., infsn 30 mg/kg in 50 mL 5%dex-hep at 1–4 mL/h (10–40 mcg/kg per min). Incompatible with aminophylline, magnesium and salbutamol.

L.

Levodopa + benserazide (4 : 1) Adult (NOT /kg): initially levodopa 100 mg 8 H oral; ifnot controlled, incr wkly by 100 mg/day to max. 250 mg 6 H.

Levodopa + carbidopa 250 mg/25 mg and 100 mg/10 mg tabs. Adult (NOT /kg): initially one 100/10 tab 8 H oral; if not controlled, substitute one 250/25 tab for one 100/25 tab every 2nd day; if not controlled on 250/25 8 H, incr by one 250/25 tab every 2nd day to max. 6–8 tab/day.

Lignocaine (lidocaine) I.v.: 1% soltn 0.1 mL/kg (1 mg/kg) over 2 min, then 0.09–0.3 mL/kg per hour (15–50 mcg/kg per min); or 30 mg/kg in 50 mL 5%dex-hep at 50 mL/h for 2 min, then 1.5–15 mL/h (15–50 mcg/kg per min). Nerve block: without adrenaline max. 4 mg/kg (0.4 mL/kg of 1%), with adrenaline 7 mg/kg (0.7 mL/kg of 1%). Topical spray: max. 3–4 mg/kg (Xylocaine 10% spray pack: ∼10 mg/puff). Topical 2% gel, 2.5% compound mouth paint/gel (SM-33), 2% and 4% soltn, 5% ointment, 10% dental ointment: apply 3 H prn. See Pain management, chapter 4, page 60.

Lignocaine (lidocaine) 2.5% + prilocaine 2.5% Cream (EMLA): 1.5 g/10cm2 under occlusive dressing for 1–3 h.

Lisinopril 0.1 mg/kg (adult 5 mg) daily oral, may incr over 4–6 wk to 0.2–1 mg/kg (adult 10–20 mg) daily.

Lorazepam 0.02–0.06 mg/kg (adult 1–3 mg) 8–24 H oral. I.v.: 0.05–0.2 mg/kg i.v. over 2 min, then 0.01–0.1 mg/kg per hour. .

M.

Magnesium sulfate Defi ciency: 50% mag sulf (2 mmol/mL) 0.2 mL/kg (max. 10 mL) 12 H i.m., slow i.v. Asthma, digoxin tachycardia, eclampsia, prem labour, pul ht: 50% 0.1 mL/kg (50 mg/kg) i.v. over 20 min, then 0.06 mL/kg per hour (30 mg/kg per hour); keep serum Mg 1.5–2.5 mmol/l (pul ht 3–4 mmol/l). Myoc infarct (NOT /kg): 50% 2.5 mL/h (5 mmol/h) i.v. for 6 h, then 0.5 mL/h (1 mmol/h) for 24–48 h. VF: 50% 0.05–0.1 mL/kg (0.1–0.2 mmol/kg) i.v. Incompatible with aminophylline, ketamine, salbutamol. Laxative: 0.5 g/kg (max. 15 g) as 10% soltn 8 H for 2 days oral.

Mannitol 0.25–0.5 g/kg i.v. (2–4 mL/kg of 12.5%, 1.25–2.5 mL/kg of 20%, 1–2 mL/kg of 25%) 2 H prn, provided serum osmolality <320–330 mmol/L.

Meropenem 10–20 mg/kg (adult 0.5–1 g) 8 H i.v. over 5–30 min. Severe inftn: 20–40 mg/kg (adult 1–2 g) 12 H (1st wk life) 8 H (>1 wk) or constant infsn.

Metronidazole 15 mg/kg (max. 1 g) stat, then 7.5 mg/kg (max. 1 g) 12 H in neonate  (1stmaintenance dose 48 h after load if <2 kg, 24 h in term baby), 8 H (4+ wk) i.v., PR or oral. Giardiasis: 30 mg/kg (adult 2 g) daily ×3 oral. Amoebiasis: 15 mg/kg (adult 750–800 mg) 8 H oral for 10 days, usually followed by diloxanide furoate 10 mg/kg (adult 500 mg) 8 H oral for 10 days. Topical gel 0.5%: apply daily. Level 60–300 μmol/mL (×0.17 mcg/mL). Midazolam Sedation: usually 0.1–0.2 mg/kg (adult 5 mg) i.v. or i.m., up to 0.5 mg/kg used safely in children; 0.2 mg/kg (repeated in 10 min if reqd) nasal; 0.5 mg/kg (max. 20 mg) oral. Infusion (ventltd): 3 mg/kg in 50 mL 5%dex-hep at 1–4 mL/h (1–4 mcg/kg per min); fi tting usually 2–4 mL/h (range 1–18 mL/h); sedatn 1 mL/h + clonidine 0.5–2 mcg/kg per hour.

Milrinone<30 kg: 1.5 mg/kg in 50 mL 5%dex-hep, 2.5 mL over 1 h (75 mcg/kg), then 1–1.5 mL/h (0.5–0.75 mcg/kg per min). >30 kg: 1.5 mg/kg made up to 100 mL in 5%dexhep, 5 mL over 1 h (75 mcg/kg), then 2–3 mL/h (0.5–0.75 mcg/kg per min).In CMH Dhaka- Inj. Milrinone 50 mcgm/kg over 10 min then 0.3-0.7 mcgm/kg/min

Morphine Half-life 2–4 h i.m.: neonate 0.1 mg/kg, child 0.1–0.2 mg/kg, adult 10–20 mg; 1/2 this i.v. over 10 min. i.v. (ventltd): 0.1–0.2 mg/kg per dose (adult 5–10 mg). Infsn of 1 mg/kg in 50 mL 5%dex-hep: ventltd neonate 0.5–1.5 mL/h (10–30 mcg/kg per hour), child or adult 1–4 mL/h (20–80 mcg/kg per hour). Patient controlled: 20 mcg/kg boluses (1 mL of 1 mg/kg in 50 mL) with 5 min lockout time + (in child) 5 mcg/kg per hour. Oral double i.m. dose; slow release: start with 0.6 mg/kg 12 H and incr every 48 h if reqd.

N.

Nalidixic acid 15 mg/kg (adult 1 g) 6 H oral, reducing to 7.5 mg/kg (adult 500 mg) 6 H after 2 wk.

Nifedipine Caps 0.25–0.5 mg/kg (adult 10–20 mg) 6–8 H, tabs 0.5–1 mg/kg (adult 20–40 mg) 12 H oral or sublingual.

Nitric oxide 1–40 ppm (up to 80 ppm used occasionally). 0.1 L/min of 1000 ppm added to 10 L/min gas gives 10 ppm. [NO] = Cylinder [NO] × (1 – (Patient FiO2/Supply FiO2)). [NO] = Cylinder [NO] × NO fl ow/total fl ow.

Nitroglycerine 1-10mg/kg/min IV. Pulmonary vasodilation-5 mcgm/kg/min

Nitroprusside 0.5-10 mcgm/kg/min IV

Nystatin 100 000 u <12 mo, 500 000 u (1 tab) >12 mo 6 H NG or oral. Prophylaxis: 50 000 u <12 mo, 250 000 u >12 mo 8 H. Topical: 100 000 u/g gel, cream or ointment 12 H. Vaginal: 100 000 u 12–24 H.

O.

Ofloxacin 5 mg/kg (adult 200 mg) 8–12 H, or 10 mg/kg (adult 400 mg) 12 H oral or i.v. over 1 h. 0.3%: 1 drop/eye hrly for 2 days (4 H overnight), reducing to 3–6 H.

Omeprazole Usually 0.4–0.8 mg/kg (adult 20–40 mg) 12–24 H oral. ZE synd: 1 mg/kg (adult 60 mg) 12–24 H oral, incr up to 3 mg/kg (adult 120 mg) 8 H if reqd. I.v.: 2 mg/kg (adult 80 mg) stat, then 1 mg/kg (adult 40 mg) 8–12 H. H. pylori: 0.8 mg/kg (adult 40 mg) daily oral with metronidazole 8 mg/kg (adult 400 mg) 8 H + amoxycillin 10 mg/kg (adult 500 mg) 8 H for 2 wk.

Ondansetron I.v.: prophylaxis 0.15 mg/kg (adult 4 mg); treatment 0.2 mg/kg (adult 8 mg) over 5 min, or 0.2–0.5 mcg/kg per min. Oral: 0.1–0.2 mg/kg (usual max. 8 mg) 6–12 H.

P.

Penicillin, benzathine 1 mg = 1250 u. Usually 25 mg/kg (max. 900 mg) i.m. once. STI: 40 mg/kg (max. 1.8 g) i.m. once. Strep proph: 25 mg/kg (max. 900 mg) i.m. 3–4 wkly, or 10 mg/kg i.m. 2 wkly.

Penicillin, benzyl (penicillin G, crystalline) 1 mg = 1667 u. 30 mg/kg 6 H. Severe inftn:50 mg/kg (max. 2 g) i.v. 12 H (1st wk life), 6 H (2–4 wk), 4 H or constnt infsn (>4 wk).

Penicillin, procaine 1 mg = 1000 u. 25–50 mg/kg (max. 1.2–2.4 g) 12–24 H i.m. Single dose: 100 mg/kg (max. 4.8 g).

Pethidine 0.5–1 mg/kg (adult 25–50 mg) i.v., 0.5–2 mg/kg (adult 25–100 mg) i.m. (halflife 2–4 h). Infsn: 5 mg/kg in 50 mL at 1–4 mL/h (0.1–0.4 mg/kg per hour). PCA 5 mg/kg in 50 mL: usually bolus 2 mL with lockout 5 min, optional background 0.5 mL/h.

Phenobarbitone (phenobarbital) Loading dose in emergency: 20–30 mg/kg i.m. or i.v. over 30 min stat. Ventilated: repeat doses of 10–15 mg/kg up to 100 mg/kg per day (beware hypotension). Usual maintenance: 5 mg/kg (adult 300 mg) daily i.v., i.m. or oral. Infant colic: 1 mg/kg 4–8 H oral. Level 80–120 umol/L (×0.23 = mcg/mL) done Mo–Fr 1100 at RCH.

Phenoxymethylpenicillin (penicillin V) 7.5–15 mg/kg (adult 250–500 mg) 6 H oral. Proph: 12.5 mg/kg (adult 250 mg) 12 H oral.

Phentolamine 0.1 mg/kg IV stat then 5-50 mcgm/kg/min

Phenytoin Loading dose in emergency: 15–20 mg/kg (max. 1.5 g) i.v. over 1 h. Initial maintenance, oral or i.v.: 2 mg /kg 12 H (preterm); 3 mg/kg 12 H (1st wk life), 8 H (2 wk–4 yr), 12 H (5–12 yr); 2 mg/kg (usual max. 100 mg) 8 H >12 yr. Level 40–80 umol/L(×0.25 = mcg/mL).

Piperacillin 50 mg/kg (adult 2–3 g) 6–8 H i.v. Severe inftn: 75 mg/kg (adult 4 g) 8 H (1st wk life) 6 H (2–4 wk) 4–6 H (>4 wk) or constant infsn.

Platelets 10 mL/kg i.v. stat, then as reqd. 1 unit ∼60 mL.

Potassium Deficiency: usually 0.3 mmol/kg per hour (max. 0.4 mmol/kg per hour) for 4–6 h i.v., then 4 mmol/kg per day. Max oral dose 1 mmol/kg (<5 yr), 0.5 mmol/kg (>5 yr). Maintenance 2–4 mmol/kg per day. If peripheral i.v., max. 0.05 mmol/mL. 1 g KCl = 13.3 mmol K, 7.5% KCl = 1 mmol/mL.

Propranolol I.v.: 0.02 mg/kg (adult 1 mg) test dose then 0.1 mg/kg (adult 5 mg) over 10 min (repeat ×1–3 prn), then 0.1–0.3 mg/kg (adult 5–15 mg) 3 H. Oral: 0.2–0.5 mg/kg (adult 10–25 mg) 6–12 H, slow incr to max. 1.5 mg/kg (max. 80 mg) 6–12 H if required.

R.

Ramipril 0.05 mg/kg (adult 2.5 mg) oral daily, may incr over 4–6 wk to 0.1–0.2 mg/kg (adult 5–10 mg) daily.

Ranitidine I.v.: 1 mg/kg (adult 50 mg) slowly 6–8 H, or 2 mcg/kg per min. Oral: 2–4 mg/ kg (adult 150 mg) 8–12 H, or 300 mg (adult) at night.

T.

Tazobactam:125 mg + piperacillin 1 g See piperacillin.

Teicoplanin 250 mg/m2 i.v. over 30 min stat, then 125 mg/m2 i.v. or i.m. daily. Severe inftn: 250 mg/m2 12 H ×3 doses, then 250 mg/m2 i.v. or i.m. daily.

Tranexamic acid Oral: 15–25 mg/kg (adult 1–1.5 g) 8 H. I.v.: 10–15 mg/kg (adult 0.5–1 g) 8 H.

Trimethoprim: 3–4 mg/kg (usual max. 150 mg) 12 H, or 6–8 mg/kg (usual max. 300 mg) daily oral or i.v. Urine prophylaxis: 1–2 mg/kg (adult 150 mg) at night oral.

Trimethoprim-sulfamethoxazole See co-trimoxazole.

U.

Urokinase:4000 u/kg i.v. over 10 min, then 4000 u/kg per hour for 12 h (start heparin 3– 4 h later). Blocked cannula: instil 5000–25 000 u (NOT /kg) in 2–3 mL saline for 2–4 h. Empyema: 2 mL/kg of 1500 u/mL in saline, position head up/down and right side up/down30 min each, then drain. Pericard eff: 10 000 u/mL, 1 mL/kg (max. 20 mL), clamp 1 h, drain.

V.

Vancomycin 10 mg/kg (adult 500 mg) 6 H i.v. over 1 h, or 1 g 12 H in adult i.v. over 2 h. Newborn (any gestation): 10 mg/kg 8 H i.v. over 1 h. Oral: 10 mg/kg to nearest 125 mg (adult 500 mg) 6 H. Intraventric (NOT /kg): 10 mg 48 H. Trough 5–10 mg/L (peak 20–40 mg/L).

Verapamil I.v.: 0.1–0.2 mg/kg (adult 5–10 mg) over 10 min, then 5 mcg/kg per min. Oral:1–3 mg/kg (adult 80–120 mg) 8–12 H.

W.

Warfarin:Usually 0.2 mg/kg (adult 5 mg) stat, 0.2 mg/kg (adult 5 mg) next day providing INR <1.3, then 0.05–0.2 mg/kg (adult 2–5 mg) daily oral. INR usually 2–2.5 for prophylaxis,2–3 for treatment. Beware drug interactions.

Whole blood 6 mL/kg raises Hb 1 g%. 1 bag = ∼400 mL.

Ref: Drug Doses by Frank Shann ICU, Royal Children’s Hospital, Parkville, Australia. (16th Edition)

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