What Antibiotics Are Appropriate to Prescribe to Children?

Full general prescribing principles for children

Prescribing of any drug in children requires very careful consideration of age, weight, and pharmacologic aspects of the drug in question. Children are particularly susceptible to agin drug reactions and dosing errors, and this is compounded by the lack of paediatric labelling details for many common prescription drugs. The pharmacokinetics and pharmacodynamics of a given drug is often very dissimilar in children, compared to adults, and may vary considerably depending on the child's historic period and stage of evolution.

In general, drug dosing in children should be weight-based (mg/kg), though note that the recommended weight-based dose may vary according to age (for example, the half-life of many drugs is prolonged in immature infants, compared to older children, resulting in lower recommended doses according to weight). Also, maximum dose limits must be taken into account and for most drugs the adult maximum dose should non be exceeded.

Paediatric dosing tables are included in these guidelines to help determine the optimal dose when antibiotics are required in children. Notwithstanding, these tables do not replace clinical acumen, and doses should be adapted accordingly if the child's weight or developmental phase is considered to be outside of the typical values. If in doubt, use the weight-based dosing included in the tables. Usually treatment for children <3months (12 weeks) is non initiated in the customs setting. Nevertheless, dosing information for this age grouping may exist included here for information purposes just and should not be interpreted every bit a recommendation to prescribe.

Key principles for management of infections in children

• Sepsis should e'er be considered. Sepsis is a clinical syndrome resulting from a dysregulated immune response to infection. Cardinal diagnostic factors include;
  • Fever or low trunk temperature
  • Tachypnea
  • Tachycardia
  • Bradycardia (neonates and infants)
• Clinical cess, based on the kid's age, history, risk factors, and physical exam, is critical in determining the presence of infection, the likelihood of viral versus bacterial infection, and severity.
• The vast bulk of infections in children are acquired past viruses, and antibody therapy provides no benefit.
• For many childhood infections, even when bacteria are implicated, the potential for damage from antibiotic therapy greatly outweighs any potential benefit.
• Children are less likely to carry resistant bacteria, compared to adults. Thus, where antibody therapy is indicated, narrow-spectrum agents should be used equally starting time-line therapy
• A "spotter and wait" approach (+/- a delayed or "only if" prescription) is appropriate for many childhood infections, particularly if clinical assessment indicates a likely viral infection or an infection for which antibiotic therapy is unlikely to be of firsthand benefit.
• Where antibiotic therapy is indicated, using the optimal dose for the shortest possible elapsing maximises the potential for eradicating the infection while minimising the adventure of antibiotic resistance and secondary infections.
• The age bands for children apply to children of boilerplate size. In practice, they will be used alongside other factors such as the severity of the condition being treated and the kid's size in relation to the average size of children of the same historic period.
• In general, the recommended duration of antibiotics in children is shorter than for like atmospheric condition in adults.

Management of hurting and discomfort associated with infection and fever:

• The use of paracetamol (or ibuprofen if necessary) can be used to help manage pain and distress associated with infection and fever in children.
• The only purpose for treating fever in children must be to relieve the kid's discomfort and not to lower the body temperature.
• Paracetamol/Ibuprofen will non foreclose delirious convulsions and should not exist used specifically for this purpose.
• Start past giving either paracetamol or ibuprofen.
• Proceed the medication merely as long every bit the kid appears distressed.
• Consider irresolute to the other amanuensis if the child'southward distress is not alleviated.
• Avoid ibuprofen in children with varicella zoster infection (chicken pox) every bit there are concerns that NSAIDs increase the risk of serious soft-tissue infections.
• Paracetamol or Ibuprofen should non be given at the same time. There is express bear witness of effectiveness, potential for confusion, risk of drug administration errors and limited condom data.
• Merely consider alternate these agents if the distress persists or recurs before the next dose is due.
  • I.due east Give paracetamol to starting time with and after an hour their temperature is yet high and they are yet distressed, try giving them ibuprofen, then paracetamol the side by side time, then ibuprofen the next time and and so on.
• Requite upward to four doses of paracetamol over 24 hours and / or upward to three doses of ibuprofen over 24 hours if required. Practise non give more than than this.
  
  • Leave four to 6 hours betwixt each dose of paracetamol and 6 to 8 hours between each dose of ibuprofen.
• Offer child regular fluids
  • In children who are breastfed, the most appropriate fluid is breast milk
• Children with fever should avoid creche/schoolhouse while the child'due south fever persists and the creche/schoolhouse should be notified of the disease.
• Advice in relation to return to school following a temperature in children during the COVID-xix pandemic is bachelor.
• Parent/Carer's advice for management of high temperature in children, including signs of dehydration and when to seek medical communication is available on www.undertheweather.ie
• The product packaging (& SPC) of paracetamol and ibuprofen, which come in two unlike strengths, contain prescribing details, which are age-based for paracetamol and age-based and weight-based for ibuprofen.
• Weight-based dosing charts for paracetamol and ibuprofen are available beneath which may be useful for doctors to use in certain circumstances, and for pharmacists to verify. Doctors tin use their clinical judgement to decide when dosing by weight is more than advisable (due east.m. for underweight children) as per the dosing charts.
  
  • Weight-based dosing for Paracetamol in Children PDF 785.3 KB
  • Weight-based dosing for Ibuprofen in Children PDF 781.7 KB

Tables

• Amoxicillin

• CefaLEXIN

• Clarithromycin

• Co-amoxiclav

• Doxycycline

• Flucloxacillin

• Metronidazole

• Nitrofurantoin

• Phenoxymethylpenicillin (Penicillin V)

• Trimethoprim

Amoxicillin

Age	Normal dose	Maximum dose	Maximum dose check (average weight for age) Based on 90mg/kg/day
1-eleven months	125mg per dose to be given every 8 hours	30mg/kg per dose to exist given every eight hours	1 calendar month (4.3kg): 129mg every eight hours xi months (8kg): 240mg every eight hours
one-iv years	250mg per dose to be given every 8 hours	30mg/kg per dose to be given every eight hours	i year (9kg): 270mg every 8 hours four yrs (16kg): 480mg every eight hours
5-eleven years	500mg per dose to be given every 8 hours	30mg/kg* per dose to be given every 8 hours *Maximum of 1g/dose	5 yrs (18kg): 540mg every 8 hours 11 yrs (35kg): 1g every 8 hours
12-17 years	500mg per dose to exist given every 8 hours	1g every 8 hours	1g every 8 hours

Preparations available:
Amoxicillin pulverization for suspension 125mg/5ml and 250mg/5ml
Capsules: 250mg and 500mg

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Cefalexin

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Age	Normal dose	Maximum dose	Maximum dose check (boilerplate weight for age) Can be dosed at upwardly to 100mg/kg/day (max 1g QDS) under specialist advice
1-11 months	125mg per dose to be given every 12 hours	12.5mg/kg/per dose to be given every 12 hours	1 month (iv.3kg): 430mg/day xi months (8kg): 800mg/day
one-four years	125mg per dose to be given every eight hours	12.5mg/kg/per dose to exist given every 12 hours	one twelvemonth (9kg): 900mg/day four yrs (16kg): 1600mg/day
5-11 years	250mg per dose to be given every eight hours	12.5mg/kg/per dose to be given every 12 hours	5 yrs (18kg): 1800mg/day 11 yrs (35kg): 3500mg/day Max. per dose 1 k every 6 hours
12-17 years	500mg per dose to be given every 8 - 12 hours	1-1.5g every 6 -viii  hours	1-one.5g every half dozen-8  hours

Preparations available:
Cefalexin 125mg/5ml and 250mg/5ml powder for oral suspension,
Capsules: 250mg and 500mg

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Clarithromycin

Age	Normal dose	Maximum dose cheque (boilerplate weight for age)
1-11 months	7.5mg/kg per dose to be given every 12 hours	1 month (four.3kg): 32.25mg every 12 hours eleven months (8kg): 60mg every 12 hours
1-ii years	62.5mg per dose to be given every 12 hours
3-6 years	125mg per dose to be given every 12 hours
seven-9 years	187.5mg per dose to exist given every 12 hours
10-12 years	250mg per dose to exist given every 12 hours
>12-17 years	250 - 500mg per dose to exist given every 12 hours

Preparations bachelor:
Clarithromycin Granules for Oral Solution: 125mg/5mls and 250mg/5mls.
Tablets: 250mg and 500mg.
Prolonged release tablets non recommended in children <12 years.

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Co-amoxiclav

*Three times daily (TDS) 125/31.25 mg in 5mL Oral Suspension Dosing Table*

Warning: In the small number of instances where Amoxicillin/clavulanic acrid is indicated, a twice daily preparation of Amoxicillin/clavulanic acid 400/57 mg in five ml is not recommended for first line therapy

Children aged less than 2 years

*NB: Dose expressed as amoxicillin/clavulanic acrid combined i.eastward. 156 mg = 125 mg amoxicillin + 31.25 mg clavulanic acid in 5 mL

Weight	Balmy-moderate infection 8.3 mg/kg* TDS		Astringent infection 16.7 mg/kg* TDS
	Dose in mg	Dose in mL	Dose in mg	Dose in mL
two kg	17 mg* TDS	0.five mL TDS	33 mg* TDS	i.one mL TDS
iii kg	25 mg* TDS	0.8 mL TDS	l mg* TDS	i.6 mL TDS
iv kg	33 mg* TDS	1.1 mL TDS	67 mg* TDS	2.i mL TDS
5 kg	42 mg* TDS	1.3 mL TDS	84 mg* TDS	two.vii mL TDS
vi kg	50 mg* TDS	ane.half-dozen mL TDS	100 mg* TDS	3.two mL TDS
vii kg	58 mg* TDS	1.nine mL TDS	117 mg* TDS	3.7 mL TDS
8 kg	66 mg* TDS	two.1 mL TDS	134 mg* TDS	4.3 mL TDS
nine kg	75 mg* TDS	2.four mL TDS	150 mg* TDS	4.8 mL TDS
10 kg	83 mg* TDS	ii.seven mL TDS	167 mg* TDS	5.4 mL TDS
11 kg	91 mg* TDS	2.9 mL TDS	184 mg* TDS	5.9 mL TDS
12 kg	100 mg* TDS	3.2 mL TDS	200 mg* TDS	6.4 mL TDS
13 kg	108 mg* TDS	3.v mL TDS	217 mg* TDS	seven mL TDS
14 kg	116 mg* TDS	3.7 mL TDS	234 mg* TDS	7.v mL TDS
15 kg	125 mg* TDS	4 mL TDS	251 mg* TDS	8 mL TDS

Children Anile ii-12 years and weighing less than 40kg

*NB: Dose expressed equally amoxicillin/clavulanic acid combined i.eastward. 156mg = 125mg amoxicillin + 31.25mg clavulanic acrid in v mL

Age	Mild-moderate infection		Severe infection
	Dose in mg	Dose in mL	Dose in mg	Dose in mL
1-v years (>15kg)	156 mg* TDS	5 mL TDS	312 mg* TDS	10 mL TDS
half dozen-12 years**	312 mg* TDS	10 mL TDS	625 mg* TDS	20 mL TDS

**In 6- 12 years you may wish to consider a twice daily (BD) dosing formulation (of ratio 7:1 such as Augmentin Duo ®) of amoxicillin-clavulanic acid to reduce volume of suspension necessary for correct dose. Consult with pharmacist to calculate dose

Children >12 years, OR weighing xl kg or greater, and Adults:

625 mg TDS (tablet formulation: 625 mg = amoxicillin/clavulanic acid 500/125 mg) or 625 mg TDS (20 mL TDS of amoxicillin/clavulanic acid 125/31.25 mg in v mL)

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Doxycycline

(excluding Lyme Disease – see Lyme Illness folio for specific guidance)

Age	Normal dose	Maximum dose check: (boilerplate weight for age*)
8 <12 years	<45kg: Day one: 4.4mg/kg/mean solar day in 1-2 divided doses. Day ii onwards: 2.2mg/kg/day in i-2 divided doses. ≥45kg: Day 1: 200 mg daily in one–two divided doses. Day ii onwards: 100 mg daily.	8 years (26kg)* Solar day 1: 114.4mg/day Day 2 onwards: 57.2mg/twenty-four hours 12 years (39kg)* Day i: 171.6mg/day Day ii onwards: 85.8mg/day For 44kg weight: Day 1: 193.6mg/mean solar day 24-hour interval 2 onwards: 96.8kg/twenty-four hours
12- 17 years	Day one: 200 mg daily in 1–2 divided doses. Solar day 2 onwards: 100 mg daily.	Every bit per normal dose

Preparations available:
Doxycycline capsules/tablets 50mg & 100mg
Dispersible tablets 100mg. This is an unlicensed product, cheque availability with community pharmacist.

Sample adding (information for dispensing chemist)

Child requiring treatment using Doxycycline 100mg unlicensed dispersible tablets:
Child weight=30kg (specify child weight on prescription)
Dose: 4.4mg per kg
30kg x four.4mg/kg = 132mg dose required i.e. 100mg + 32mg

How to disperse tablet to give a function dose of 32mg:
Dissolve 1x 100mg dispersible doxycycline tablet in 5mL of water.
100mg=5mL so 32mg=1.6mL.(Draw up and give one.6ml using 5ml syringe supplied by chemist to give 32mg).

Therefore for a total dose of 132mg, give the appropriately dispersed 100mg tablet plus 1.6mL (32mg) of the dispersed liquid prepared every bit in a higher place.

Discard remaining dose past returning to local pharmacy in child resistant closure container. If required, to better palatability, can add squash/fruit juice to h2o. Make dose fresh each time.

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Flucloxacillin

Age	Normal dose	Maximum dose bank check (average weight for age)
1 month- < 2 years	62.5mg - 125mg per dose to be given every half-dozen hours	125mg per dose to be given every half-dozen hours
2-10 years	125mg-250mg per dose to exist given every 6 hours	250mg per dose to exist given every half dozen hours
ten-17 years	250mg-500mg per dose to exist given every half dozen hours	500mg per dose to exist given every 6 hours

Preparations available:
Flucloxacillin capsules 500mg
Flucloxacillin powder for oral suspension: 125mg/5ml and 250mg/5ml

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Metronidazole – for treatment of anaerobic (non-dental) infections

Age	Normal dose	Maximum dose check (average weight for age)
1-ii months	7.5mg/kg per dose to exist given every 12 hours	1month (4.3kg): 32.25mg every 12 hours 2 months (five.4kg): 40.5mg every 12 hours
≥2 months-12 years	seven.5mg/kg per dose every 8 hours	2 months (5.4kg): xl.5mg every 8 hours 12 yrs (39kg): Max of 400mg every 8 hours
12-17 years	400mg every viii hours	Max 400mg every 8 hours

Preparations available:
Metronidazole tablets 200mg & 400mg
Metronidazole liquid 200mg/5ml strength*

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Nitrofurantoin

Age	Normal dose	Maximum dose bank check: (boilerplate weight for historic period)
3 – 5 months	0.75mg/kg per dose to be given every 6 hours	iii months (5kg): three.75mg to exist given every 6 hours v months (7kg): v.25mg to exist given every 6 hours
6 months-3 years	0.75mg/kg per dose to be given every vi hours	6 months (8kg): 6mg to be given every 6 hours 3 years (14kg): x.5mg to be given every 6 hours
iv-vii years	0.75mg/kg per dose to be given every 6 hours	4 years (16kg): 12mg to be given every 6 hours 7 years (23kg): 17.25mg to be given every 6 hours
8-12 years	0.75mg/kg per dose to be given every 6 hours	8 years (26kg): nineteen.5mg to be given every 6 hours 12 years (39kg): 29.25mg to exist given every 6 hours
>12 years and adults	50mg to be given every 6 hours (using immediate release product) Or 100mg every 12 hours (using the modified-release product)

Preparations available:
Nitrofurantoin 50mg firsthand release tablets
Nitrofurantoin 100mg modified release capsules

Unlicensed Nitrofurantoin 25mg/5ml oral break bachelor for children. Consult with pharmacist regarding availability and pricing.

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Phenoxymethylpenicillin (Penicillin V)

Historic period	Normal dose	Maximum dose	Maximum dose check Based on 12.5mg/kg every 6 hours
1-11 months	62.5mg per dose to be given every 6 hours	12.5 mg/kg per dose to exist given every half-dozen hours	1 month (iv.3kg): 53.75mg every 6 hours 11 months (8kg): 100mg every 6 hours
1-five years	125mg per dose to be given every half dozen hours	12.5 mg/kg per dose to be given every vi hours	ane yr (9kg): 112.5mg every vi hours 5 yrs (18kg): 225mg every 6 hours
vi-11 years	250mg per dose to be given every half dozen hours (Kopen tablet or liquid training) or 333mg per dose to exist given every half dozen hours (Calvepen tablet)	12.5 mg/kg per dose to be given every 6 hours	6 yrs (20kg): 250mg every 6 hours 12 yrs (39kg): 487.5mg every 6 hours
≥12 years and Adults	500mg per dose to be given every half-dozen hours (Kopen tablet or liquid grooming) or 666mg per dose to exist given every 6 hours (Calvepen tablet)	12.5 mg/kg per dose to be given every 6 hours	As per normal dose

Preparation available:
Phenoxymethylpenicillin powder for oral solution: 125mg/5ml, 250mg/5ml. Tablets: Kopen ® 250mg,  Calvepen® 333mg and 666mg
(Note: Calvepen® 333mg tablet = 300mg phenoxymethylpenicillin,
Calvepen® 666mg tablet = 600mg phenoxymethylpenicillin)*

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Trimethoprim

Age	Normal dose: 3mg/kg every 12 hours	Maximum dose	Maximum dose bank check: Based on max. of 4mg/kg every 12 hours
6 weeks – 5 months	25mg every 12 hours	4mg/kg every 12 hours	6 weeks (5kg): 20mg every 12 hours 5 months (7kg): 28mg every 12 hours
6 months – three years	25 - 50mg every 12 hours	4mg/kg every 12 hours	6 months (8kg): 32mg every 12 hours 3 years (14kg): 56mg every 12 hours
iv-7 years	fifty - 75mg every 12 hours	4mg/kg every 12 hours	4 years (16kg): 64mg every 12 hours 7 years (23kg): 92mg every 12 hours
8-12 years	75 - 125mg every 12 hours	4mg/kg every 12 hours	eight years (26kg): 104mg every 12 hours 12 years (39kg): 156mg every 12 hours
>12 years and Adults	200mg every 12 hours		200mg every 12 hours

Preparations available:
Trimethoprim 10mg/ml oral solution
Trimethoprim 100mg and 200mg tablets

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Weight and Top Table, Adjusted from BNF for Children accessed via Medicines Complete (terminal updated 08 March 2022)

The table shows the mean values for weight and height and gender by age; these values may be used to summate doses in the absenteeism of actual measurements. However, the child'south bodily weight and superlative might vary considerably from the values in the table and information technology is important to see the child to ensure that the value chosen is appropriate. In virtually cases the child'south bodily measurement should be obtained every bit soon as possible and the dose re-calculated.

Age	Weight (kg)	Peak (cm)
Full-term neonate	3.5	51
1 calendar month	4.3	55
ii months	5.4	58
three months	6.1	61
4 months	half-dozen.vii	63
six months	7.6	67
1 yr	9	75
3 years	14	96
5 years	18	109
7 years	23	122
10 years	32	138
12 years	39	149
14 year-old male child	49	163
14 year-onetime daughter	50	159
Adult male	68	176
Developed Female	58	164

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Conversion to units table

Approximate conversions and units
lb	kg		stones	kg		ml	fl oz
1	0.45		1	6.35		fifty	1.8
two	0.91		2	12.7		100	3.v
3	1.36		3	19.05		150	v.iii
iv	ane.81		4	25.40		200	7.0
five	two.27		5	31.75		500	17.6
half-dozen	two.72		six	38.10		k	35.2
seven	iii.xviii		seven	44.45
8	3.63		viii	l.80
9	iv.08		9	57.15
ten	4.54		x	63.fifty
xi	four.99		11	69.85
12	5.44		12	76.20
13	5.90		thirteen	82.55
14	6.35		xiv	88.90
			15	95.25

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Page reviewed March 2022

begglere1964.blogspot.com

Source: https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/prescribing-for-children/

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