Pediatric dosage

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Pediatric dosage

  1. 1. Pediatric Dosage 小兒科藥物劑量 資料來源 : 三軍總醫院 小兒部
  2. 2. Common Dose 一般劑量 • > 20kg :錠劑磨粉 – – – – 40Kg : 1 # po qid 30Kg : 1 # po tid 20Kg : 1/2# po qid 10Kg : 1/4# po qid 若可吞 , 不用磨 • < 20kg :糖漿 – – – 一般咳嗽 ˙ 流鼻水糖漿多為 BW/4 c.c. 退燒 ˙ 抗生素糖漿多為 BW/2 c.c. 例外: 止瀉藥水 ˙ 氣管擴張劑糖漿 ˙ 紅黴素類糖漿
  3. 3. Antipyretics 退燒藥 • Scanol (500mg/1#) : – 10 ~ 15mg/kg/dose q4h ~ q6h (50 mg/kg/day) • Antiphen (Acetaminophen syrup) : – BW/2 ㏄ q4h prn if BT ≥ 38.5℃(120mg/kg/dose) 38.5℃ • Sconin(Ibuprofen syrup) : NSAIDs – ≥ 38.5℃ : BW/4 cc q6h ;  39.5℃ : BW/2 cc q6h • Diclofen (supp)( 12.5mg ) : – < 6kg 1/3# supp q6h prn if BT ≥ 39.5℃ – 6 ~ 10kg 1/2# supp q6h prn if BT ≥ 39.5℃ – > 10kg 1# supp q6h prn if BT ≥ 39.5 ℃
  4. 4. Antitussives and expectorants 止咳化痰藥 • Medicon-A ( 20mg/cap ): Common dose • Medicon syrup (Dextromethorphan) (2.5mg/ml) : – BW/4 cc po qid ,1-2mg/kg/day q6-8h • Mucosolven (Ambroxol liq.)(3mg/ml) ( 化痰 ): – BW/4 cc qid ;<2 y/o:2.5~5 cc bid; 2~5y/o:2.5~5 cc tid ; 5~10y/o 5~10cc tid • Unitussin (Glyceryl guaiacolate)(20mg/ml)( 化痰 > 止咳 ): – BW/4 cc qid ; 2~6y/o:2.5~5 cc qid ; 6~12y/o 5~10cc qid
  5. 5. Antihistamines & Decongestants 流鼻水 , 鼻塞‚抗過敏藥 • Cyproh syrup (Cyproheptadine 0.4 mg/ml) : — BW/4 cc po qid • Cyproh tablet ( 嗜睡 , 增加食慾 ) : Common dose • Demin (Chlorpheniramine 0.5mg/ml ) : — BW/4 cc po qid • CTM tablet ( 嗜睡 , 使痰更濃 ) : Common dose • Venalin (Diphenhydramine 30mg/amp): 10-50mg IV or IM q2-3h, max 400mg/day (1mg/kg/dose) – Urticaria, angioedema or EPS 時可用
  6. 6. Antihistamines & Decongestants 流鼻水 , 鼻塞‚抗過敏藥 • Clarityne(10mg/tab) : – < 30kg 1/2# po qd ;> 30kg 1# po qd • Clarityne syrup (Loratadine 1mg/ml 60ml ) – < 30kg 5ml po qd ;> 30kg 10ml po qd • Allegra (60mg tab) : 1# bid ->1# qd
  7. 7. Bronchodilator 氣管擴張劑 • Bricanyl (Terbutaline 2ml/5mg ) : – <20Kg:½ # in N/S 3ml for neubrilization q6h; >20Kg:1 # in N/S 3ml for neubrilization q6h • Ventolin (Salbutamol neubule 2.5ml/5mg) : – The same with Bricanyl; – Tab(2mg): 0.1 mg/kg/dose up to 2 mg PO tid • Berotec(Fenoterol HBr) syrup(0.5mg/ml) : – BW/4~BW/5 cc tid ;<1 y/o:2.5 cc bid; 1~6y/o:2.5~5 cc tid ; 6~14y/o 5cc tid • Meptin(Procaterol) syrup(mg/ml) : – <6 y/o:BW/4~BW/5 cc q12h; >6y/o:5 cc po q12h
  8. 8. Bronchodilator 氣管擴張劑 • Xidanef (Ketotifen)100 ml syrup: – 2.5-5ml bid • Atrovent (Ipratropium UDV 0.5mg/2ml): – 1 vial q6h prn • Epinephrine(1:1000) : 0.01ml/kg/dose(Max 0.5ml) q15minSC
  9. 9. Xanthines 茶鹼類 • Aminophylline • S.E : nausea, vomiting, insomnia, tachycardia • Loading dose : 5(2~6)mg/kg/dose iv drip for 20 ~ 30 min;Maintain : 1mg/ kg/hr • Infants=> 0.2~0.9mg/kg/hr, 1-9y/o=>1~1.2mg/kg/hr; • 9-16y/o=>0.8~1mg/kg/hr; • youngsmoker:0.8~1mg/kg/hr, • nonsmoker:0.5~0.7mg/kg/hr • Apnea of prematurity : 4~6mg/kg iv 30 min ,then maintaince : 1.5~3 mg/kg/dose iv q8-12h
  10. 10. Xanthines 茶鹼類 • Ventol:3ml/kg/day qid • Aminophylline tab. : 200mg/tab po qid ; dose = iv form
  11. 11. Steriods 類固醇 • Decadron : 0.1 mg/kg/dose im q8h. • Rinderon (4mg/ml): 0.1 mg/kg/dose im,iv q8h • Prednisolone(5mg/tab):1~2mg/kg/day po qd~qid ; max:4#~8#(20~40) mg/day for 3~5 day. • 40kg 給 Pulmicort (steroid ,200mcg/dose) : – 1~2 puff bid for 3 month for prevent asthma( 可有效 預防氣喘再發 )
  12. 12. Urticaria 蕁麻疹 • Benadryl (Diphenhydramine):1mg/kg IM • Decardon (Dexamethasone): – 0.1mg/kg/dose IM • Periactin tab :普通劑量 po qid. • Prednisolone(5mg/tab.) :1~2 mg/kg/day
  13. 13. Antidiarrheals, digestives and antiflatulents 止瀉、消化、消氣劑 • Kaopectin : – < 6 mons : 3 ㏄ po qid (嚴重再給) – 6 mons ~ 6 Y/O : 5 ㏄ po qid – > 6 Y/O : 10 ㏄ po qid. • Biofermin tab :普通劑量 ×2 po qid. • Simethicone tab :普通劑量 po qid. • Bismuth: 普通劑量 po qid.
  14. 14. Antiemetics 止吐劑 • • • • Motilium(10 mg/tab) :普通劑量 po qid. Prepulsid : 0.1~0.2mg/kg/dose po qid Novamine or Priperam may cause EPS EPS : Akineton=Biperidine(1#=2mg;5mg/1cc/am p) – Adult : 2mg per 30 min.max 4 vial(20mg)
  15. 15. Laxatives 輕瀉劑 • Glycerine ball enema : 0.5~1# qd • MgO tab :普通劑量 po qid. • Ducolax (Bisacodyl 5mg tab) : 6~12 yo 1# po st. • Cascara (Cascara sagrada) : 1~2# po qhs
  16. 16. Anticonvulsants 抗痙攣劑 • Valium(Diazepam)(10mg/2 ㏄ /amp): – <5y/o: 0.2 ~ 0.5mg/kg/dose iv slowly q15min × 3 ( max 5mg) – >5y/o: the same as above except (max 10 mg) – adolescents: 5-10 mg/dose; max: 30mg. • Neuropam(Lorazepan)(2mg/ml/amp) ; 中效 (1015 hrs) : – 0.03-0.1mg/kg/dose q15 ~ 20min × 2 dose max: 4mg/dose
  17. 17. Anticonvulsants 抗痙攣劑 • Dilantin(phenytoin) (250mg/5cc/amp) : – Loading 10 ~ 20mg/kg iv with rate < 1mg/kg/min,max50mg/min ,Maintain 5mg/kg/day iv q12h, ( 不可加於 Glucose solution) • Luminal(Phennobarbital) (100mg/cc/amp;32mg/1#) – Loading 20mg/kg iv with rate < 30mg/min ; Maintain 5-10mg/kg/day to achieve serum level 40 ug/ml • Chloral hydrate enema(10% 30ml) : – Neonates: 25-50 mg/kg/dose, – Children: 25-100mg/kg/dose → 1/2~3/4 BW cc enema
  18. 18. Antibiotics 抗生素 • Penicillin :Bctereimia:2.5-5 ;Meningitis 7.5-10 ; infection 10-25( 單位:萬 u/kg/dose q4-6h) • Ampicillin : IV 100mg/kg/day, q6h. • Amoxicillin Cap(500mg) : (Ac. tonsillitis, AOM) • Hiconcil Cap(250mg)=> 50 mg/kg/day q8h. • Amoxicillin syrup => BW/2 po q8h. • Augmentin (amoxicillin + clavulanic acid, 375mg/1#,600mg/vial) : BW/2 po q8h.
  19. 19. Antibiotics 抗生素 - Cephalosporins 頭芽孢 素 • Cephazolin(Veterin) : IV 100mg/kg/day, q6h. • Keflex(250mg/1#,Cephalexin 1',Ceflexin 500mg/1#):2550 mg/kg/day poq6h for G(+). • Keflor (2’ Cefaclor,250 mg/1#,125mg/5cc/60cc/susp) 50 mg/kg/day q8h.; BW/2 q8h.(AOM) • Zinacef (2’ Cefuroxime, 250mg,750mg): • <2y/o:125mg/dose po bid; >2mg:250mg/dose po bid • Zinnat (2’ Cefuroxime, 25mg/ml) • AOM : <2 y/o 5ml q12h ; >2 y/o 10ml q12h • Common infection: 5ml q12h • Rocephin,Syntrix(3’Ceftriaxone 500mg/5cc/vial): 50-100mg/kg/day iv q12h-qd; Meningitis:100mg/kg/day q12h (max:4g/day) • Prostaphlin (Oxacillin) : – IV 100mg/kg/day, q6h. (Cellulitis)
  20. 20. Antibiotics 抗生素 Macrolides • Erythromycin(Mycoplasma,Chlamydia,Legionella) • Erythrocin syrup (40mg/cc) : BW/4 cc po q6h Ilosone (250/1#):30-50 mg/kg/day q6h.(20kg 1# qid, 40kg 2# qid) • Zithromax(Azithromycin,250mg/1#,200mg/5cc/susp) • child :1# qd * 3day (>40kg:2#) • Zithromax syrup : BW/4 cc po qd * 3 days • Klaricid(Clarithromycin ,250/tab): Adult 1~2# po bid; Child:7.5mg/kg bid
  21. 21. Antibiotics 抗生素 -UTI • Nitrofurantoin(Ninru,100mg/1#) : – 5 ~ 7mg/kg/day, po qid (UTI),Adult::1#po qid. – Prophylactic dose: 1/3~1/4 therapeutic dose • Azactam(Aztreonam 1 g/inj):90-120mg/kg/day iv q6-8h for G(--) and Pseudomonas • Mycostatin( 50 萬 u/1#):for Candida(Oral thrush): – – Infant: 2/5# (20 萬 u)/dose q6h Child: 1# (40-60u)/dose q6h • Baktar(TMP-80 + SMX-400):6-12 mg/kg/day po q12h (Contraindication < 2 months,G6PD deficiency)
  22. 22. Cardiologic disease • PGE1 ( PDA ) :IV 0.05-0.1μg/kg/min • Supraventricular tachycardia – Adenosine:0.1mg/kg rapid IV push give double or triple the dose in 2-3 min (6mg max) • Digoxin(not for WPW):loading 30-40μg/kg – Give 1/2 dose, then 1/4 dose q6-8h for 2 more doses • Verapamil(Isoptin 5mg/2ml/amp, 1# 80mg): – >1y/o; 0.075-0.15 mg/kg,slow IV, repeat twice q15m
  23. 23. Fulid supplement • 0 ~ 10Kg (4 MD/kg) : 100ml/kg/day • 10 ~ 20kg(2 MD/kg) : 1000 ㏄+ ( BW - 10 ) ×50 ㏄ /day •Example 1: (1 MD/kg) : 1500 ㏄+ ( BW - 20 ) ×20 > 20kg ㏄ /day BW=25 kg,Keep IV route with 0.33%G/S ______MD/min •Ans: (10 ×4) + (10 ×2) + (5 ×1) = 65 MD/min •Example 2: BW=30 kg,Keep IV route with 0.33%G/S ______MD/min ______c.c. qd •Ans: (10 ×4) + (10 ×2) + (10 ×1) = 70 MD/min (10 ×100) + (10 ×50) + (10 ×20) = 1700 c.c./day
  24. 24. Management of Dehydration Access fluid deficit: • < 5%(mild): Consolable, Dry tongue, Mild loss of skin turgor • 5% -10%(moderate): Irritable, Reduced urine output, Deep set eyes, Tachypnea, Marked loss of skin turgor • > 10%(severe): Lethargy or Coma, Sunken anterior frontanelle and eyes, Cold extremities, Weak or impalpable pulse, Hypotension
  25. 25. Management of Dehydration • Rehydration: First 8 hr Later 16 hr Deficit 1/2 1/2 Maintenance 1/3 2/3 • e.g.: 10kg, 10% loss, ≧3 days  • Deficit : 10% x 10 (kg) x 0.6(deficit% from ECF ) X 1000 = 600 ml • Maintenance: 10 x 100 = 1000 ml First 8 hr later 16 hr Deficit 300ml 300ml Maintenance 333ml 660ml
  26. 26. Management of Dehydration • • • • Shock: Shock 20ml/kg N/S or Lactate Ringers or 10ml/kg 5% albumin, blood, plasma Loading speed: 10ml/kg/hr, ( 2ml/kg/hr in CHF )
  27. 27. Electrolyte supplement • Na : 3 ~ 4 mEq/kg/day – 3%NaCl 1ml = 0.5 mEq – 0.9% NaCl 500ml = 77mEq • K : 2 ~ 3 mEq/kg/day – 15%KCl 1ml = 2 mEq • Ca : 200~1000 mg/kg/day q8h-qd – 10% Ca gluconate(100mg/1ml,1Amp = 10ml) • NaHCO3 : 1 mEq/kg ( if PH < 7.2 ) – 17 mEq/20cc/amp
  28. 28. Correct Metabolic Acidosis Tachypnea (BE=PCO2 – 1.5 x [HCO3] + 8 ± 2 ) BE HCO3 Mild <10 >17  Observation Moderate 10-20 17-8  Slow correction Severe >20 <8  Rapid supply IVD 10’, taper the speed if PH > 7 7% NaHCO3 ( 17 mEq/20ml ) supply half in 2-8 hours: 2-4 mEq/kg/dose BE x 0.3 x BW ( 15-HCO3 ) x 0.6 x BW
  29. 29. 其他特殊用藥 • Aspirin(500mg/13): Analgesic:10-15 mg/kg/dose po q6-8h Anti-rheumatic:65-100mg /kg/day po q6-8h Kawasaki disease: 100mg/kg/day po q6h • Indocin: Dose : No.1 No.2 No.3 <48h-0.2 0.1 0.1 (mg/kg 2-7days -0.2 0.1 0.2 q12-24h ) >7 days -0.2 0.1 0.25
  30. 30. 其他特殊用藥 • Lasix(40mg/1#,20mg/2cc/inj):1-2mg/kg/dose q6-12h • Mannitol(60mg/20%/300cc):0.5-1.0g/kg/dose iv for 30min • Insulin: • DKA:0.05-0.1u/kg/hr iv drip , • maintain : 0.5-1u/kg/day/SC • Glucose intolerance in prematurity: 0.01-0.1u/kg/hr. • • • • Difflam® Anti-Inflammatory Spray (得伏寧 消炎噴液劑) ¨ 成份 :每 mL 含 Benzydamine Hydrochloride 15 mg ¨ 作用: Benzydamine 為一抗炎止痛劑,可舒解口腔及咽喉疼痛。 ¨ 用法:直接噴 5-10 次於疼痛和發炎部位,再輕輕吞 下,視需要,可每 1.5-3 小時重覆一次。
  31. 31. CPR 用藥 • E-T tube size : – Newborn : 2.5 ~ 4 Fr ; > 2 Y/O = 4 + (age / 4) Fr – Depth:lip-tip length (about = 3 * E-T tube size) – Depth: 1/ 2/ 3/ 4 kg = > 7 / 8 / 9/ 10 cm • Epinephrine ( 1 : 1000 ) : ( 1mg = 1ml ) – 0.01 ml/kg/dose iv; or 0.1 ml/kg/dose via ET tube • Dopamine : ( 6×BW ) kg in N/S final V = 100ml 1MD/min = 1ug/kg/min • N.E.(Levophed):1mg/ml; 0.05-0.1ug/kg/min drip. • Nitroprusside(Nipride): 0.5-1.0 ug/kg/min drip.
  32. 32. CPR 用藥 • Atropine : 0.02mg/kg (1ml = 0.1mg ) q5m, total max dose: child=1mg, adolescent: 2mg;minimal dose=0.1mg • NaHCO3 : 1 meq/kg ( if PH < 7.2 ) • Lidocaine(10mg/ml): 1mg/kg loading, 20-50ung/kg/min, (60xBW)mg of lidocaine dilute with N/S to 100ml, then 1MD/min10ug/kg/min • Adenosine: for PSVT – Neonates and child: 0.05mg/kg iv push, increase bolus doses by 0.05mg/kg q2min, max dose:0.25mg/kg or 12mg – Adult: 6mg12 mg 12 mg

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