Dose adjustment in pediatric age

1. Drug dose adjustment in pediatrics with renal impairment
Using Schwartz equation:
CrCl (ml/min/1.73m2)= [Height (cm) x k] / Scr
(Patient population: infants over 1 week old through adolescence (18 years old))
k = 0.33 for infants 1 to 52 weeks old (pre term)
k = 0.45 for infants 1 to 52 weeks old (term)
k = 0.55 for children 1 to 13 years old
k = 0.55 for adolescent females 13-18 years old
k = 0.7 for adolescent males 13-18 years old
Note : Serum BUN/Creatinine Ratio:
1. If BUN/SCr> 20:1  Pre-renal Acute Kidney Injury.
2. If BUN/SCr< 15:1  Intrinsic or Post-renal Acute Kidney Injury.
Presented By:
Clinical Pharmacists Team, El Galaa Pediatric Hospital, June 2016

2. Medication Normal dose GFR 30-50 GFR 10-29 GFR <10 PD IHD CRRT
Amikin 7.5 mg/kg/dose Q 12 hrs
Or
15 mg/kg/day Q 24 hrs
(not for endocarditis or
meningitis)
7.5 mg/kg/dose Q
18 hrs
7.5
mg/kg/dose
Q 24 hrs
Not recommended, if
culture based:
7.5 mg/kg/dose
Q 48-72 hrs
5 mg/kg/dose as
indicated by serum
conc
5 mg/kg/dose as
indicated by serum
conc
7.5 mg/kg/dose Q 12
hrs, monitor serum
concentrations
Augmentin Child 1-3 months:
30 mg/kg Q 12 hrs
Child 3 months-18 years:
30 mg/kg (max 1.2 gm)
Q 8 hrs
Normal Dose
15
mg/kg/dose
Q 12hrs
15 mg/kg/dose
Q24 hrs
15 mg/kg/dose
Q 24 hrs
15 mg/kg/dose
Q 24 hrs
After dialysis
Not applicable
Ceftriaxone 1month-12 years :
<50kg :
50-80 mg/kg Q24 hrs
( maximum single dose
1000 mg )
>50kg & 12-18 years :
1gm daily
in sever infection &
meningitis :
2-4 gm daily
Normal Dose Normal Dose Normal Dose Normal Dose Normal Dose
No need for
supplemental dose
Normal Dose
Ciprofloxacin 6-10mg /Kg /dose Q 8hrs
( max 400mg )
Normal Dose 10-15
mg/kg/dose Q
18 hrs
10-15 mg/kg/dose
Q 24 hrs
10-15 mg/kg/dose
Q 24 hrs
10-15 mg/kg/dose
Q 24 hrs
After dialysis
10-15 mg/kg/dose
Q 12 hrs
Claforan 50 mg/kg/dose Q 8-12 hrs
(inc to Q 6 hrs in severe inf)
Max 12gm per day
35-70
mg/kg/dose
Q 8-12 hrs
35-70
mg/kg/dose
Q 12 hrs
35-70 mg/kg/dose
Q 24 hrs
35-70 mg/kg/dose
Q 24 hrs
35-70 mg/kg/dose
Q 24 hrs
35-70 mg/kg/dose
Q 12 hrs
Colistin <60kg :25000unit /kg Q
8hrs
>60 kg : 2000000 unit
Q8hrs
750000 IU /kg
/day
Q 12-24 hrs
44000 IU /kg
Q 36 hr
‫ــــــــــــــــــــــ‬ ‫ــــــــــــــــــــــــــــ‬ 44000 IU /kg
Q 24-48 hrs
After dialysis
750000 IU /kg
Q 24 -48 hrs
Adult

3. Medication Normal dose GFR 30-50 GFR 10-29 GFR <10 PD IHD CRRT
Dalacin 3.75-6.25 mg/kg Q 6hr
sever infection :
10 mg /kg Q 6hrs
( max :1.2 gm ) may be
given Q 8hrs .
Normal Dose Normal Dose Normal Dose Normal Dose Normal Dose Normal Dose
Diflucan 3-12 mg/kg /day 50% of normal
dose Q 24 hrs
50% of normal dose
Q 24 hrs
50% of normal dose
Q48 hrs
50% of normal dose
Q48 hrs
50% of normal dose
Q48 hrs
After dialysis
6mg/kg/dose
Q 24 hrs
Flagyl Child 1-2 months:
7.5 mg/kg/dose Q 12 hrs
Child 2 months – 18
years:
7.5 mg/kg/dose Q 8 hrs
( max 500 mg)
Normal Dose Normal Dose 4 mg/kg/dose
Q 6 hrs
4 mg/kg/dose
Q 6 hrs
4 mg/kg/dose
Q 6 hrs
After dialysis
No adjustement
required
Fortum 25-50mg /kg /dose
Q 8hrs (max 6gm /day)
50 mg /kg /dose
Q 12hr
50 mg /kg /dose
Q 24 hr
50 mg /kg /dose
Q 48 hr
50 mg /kg /dose
Q 48 hr
50 mg /kg /dose
Q 48 hr
After dialysis
50 mg /kg /dose
Q 12hr
Fungizone initial test dose of 100
mic/kg (max.1mg)
included as part of first
dose of 250 mic/kg daily.
Increased over 2-4 days, if
tolerated to 1mg/kg daily
in sever infection max 1.5
mg/kg daily
Use only if no alternative, nephrotoxicity may be reduced
with use of lipid formulation. If renal dysfunction is due to
the drug, decrease the dose by 50% or the dose can be
given every other day
(1-1.5 mg/kg/dose Q 48 hrs)
Normal Dose Normal Dose Normal Dose
Gentamycin 2.5 mg/kg/dose Q 8 hrs
(Once Regimen not for
endocarditis or meningitis:
7 mg/kg Q 24 hrs.) .
pseudomonal lung infection :
3mg/kg /dose Q 8hrs
2.5 mg/kg/dose Q
12-18hrs
2.5mg/kg/dose Q
18-24 hrs
2.5 mg/kg/dose
Q 48-72 hrs
2 mg/kg/dose as
indicated by serum
conc.
2 mg/kg/dose as
indicated by serum
conc.
2 to 2.5 mg/kg/dose
Q 12 to 24 hrs ,
monitor serum
concentrations

4. Medication Normal dose GFR 30-50 GFR 10-29 GFR <10 PD IHD CRRT
Maxipime 1-2 monthes :
30mg/kg Q8-12 hrs
>2monthes:
mild infection :
50 mg/kg Q12 hrs
in severe infection
:50mg/kg Q8hrs
(max: 2gm Q8 hrs )
50 mg/kg/dose
Q 24 hours
50 mg/kg/dose Q 24
hours
50 mg/kg/dose
Q 48 hours
50 mg/kg/dose
Q 24 hours
50 mg/kg/dose
Q 24 hours
50 mg/kg/dose
Q 12hours
Meronem <50 kg : 20mg /kg/dose Q
8hrs
>50 kg : 12-18 years : 0.5-
1gm Q 8hrs
menengitis and cystic
fibrosis :
<50 kg : 40 mg/kg Q8hrs
>50 kg : 12-18 years : 2
gm Q 8hrs
Normal dose
Q 12 hrs
50% normal
dose Q 12 hrs
50% normal
dose Q 24 hrs
50% normal dose
Q 24 hrs
50% normal dose
Q 24 hrs
Normal dose
Q 12 hrs
Mycamine Invasive canidiasis :
1 month -18years
<40 kg :2mg/kg Q 24 hrs
>40kg :100-200 mg Q 24
hrs at least 14 days
Oesophageal candidiasis
: 16-18 years
< 40kg : 3mg/kg Q 24hrs
>40kg : 150 mg Q 24 hrs
Normal Dose Normal Dose Normal Dose Normal Dose Normal Dose Normal Dose
Targocid LD:10 mg/kg/dose Q 12 hrs
for 3 doses
MD: 6 mg/kg/dose (max 400
mg) Q 24 hrs
(inc to 10 mg/kg/dose Q
24 hrs in severe cases)
Normal Dose
Normal regimen for
the first three days,
then on Day 4:
6-10 mg/kg/dose Q
48 hrs
Normal regimen for
the first three days,
then on Day 4:
6-10 mg/kg/dose Q
72 hrs
Normal regimen for
the first three days,
then on Day 4:
6-10 mg/kg/dose Q
72 hrs
Normal regimen for
the first three days,
then on Day 4:
6-10 mg/kg/dose Q
72 hrs
Normal regimen for
the first three days,
then on Day 4:
6-10 mg/kg/dose Q
72 hrs

5. Medication Normal dose GFR 30-50 GFR 10-29 GFR <10 PD IHD CRRT
Tavanic Infants ≥ 6 months:
8-10 mg/kg/dose Q 12 hrs
Child > 5 years:
8-10 mg/kg/dose Q 24 hrs
(max 750 mg daily)
Normal Dose
5-10 mg/kg/dose
Q 24 hrs
5-10 mg/kg/dose
Q 48 hrs
5-10 mg/kg/dose
Q 48 hrs
5-10 mg/kg/dose Q
48 hrs
10mg/kg/dose
Q 24 hrs
not removed by dialysis;
supplemental doses are not required
Tazocin General dose:
1 month -12 years :
90 mg/kg Q 6-8 hrs
( max:4.5 gm Q 6hrs )
12-18 years :
4.5 gm Q 8hrs
increased in sever infection Q
6 hrs
child with neutropenia:
1month-18 year :
90 mg /kg ( max4.5 gm) Q
6hrs
complicated intra-
abdominal infection:
2-12 years :
112.5mg/kg ( max :4.5 gm) Q
8 hr
12-18 years:4.5 gm Q 8hrs
increased in sever infection Q
6 hrs
40 to 57mg
/kg/dose Q 6
hours
40 to 57mg /kg/dose
Q 8 hours
40 to 57mg /kg/dose
Q 8 hours
57-85mg /kg /dose
Q 12 hrs
57-85mg /kg /dose
Q 12 hrs
40 to 57mg /kg/dose
Q 8 hrs
Tienam 15-25 mg/kg / dose
( max 1 gm ) Q 6 hrs
7-13
mg/kg/dose
Q 8 hrs
7.5-12.5
mg/kg/dose
Q 12 hrs
7.5-12.5
mg/kg/dose
Q 24 hrs
7.5-12.5
mg/kg/dose
Q 24 hrs
7.5-12.5
mg/kg/dose
Q 24 hrs
7-13 mg/kg/dose
Q 8 hrs
Tigecyllin
Children 8-11 years:
1.2 mg/kg/dose Q 12 hrs
maximum single dose:
50 mg
Children ≥12 years and
Adolescents:
50 mg Q 12 hours
Normal Dose Normal Dose Normal Dose Normal Dose Normal Dose Normal Dose

6. Medication Normal dose GFR 30-50 GFR 10-29 GFR <10 PD IHD CRRT
Unasyn
150-300 mg/kg/day
Q 6 hrs
50-75
mg/kg/dose Q 8
hrs
50-75 mg/kg/dose
Q 12 hrs
50-75 mg/kg/dose
Q 24 hrs
50-75 mg/kg/dose
Q 24 hrs
50-75 mg/kg/dose
Q 24 hrs
50-75 mg/kg/dose
Q 8 hrs
Vancomycin
15 mg/kg/dose Q 8
hrs
(max daily dose = 2
gm)
10-15
mg/kg/dose Q
12 hrs
10-15
mg/kg/dose Q
18-24 hrs
10 mg/kg/dose
Redose according
to serum conc.
10 mg/kg/dose
Redose according
to serum conc.
10 mg/kg/dose
Redose according
to serum conc.
10mg/kg/dose
Q 12-24 hrs
V-fend 2-12 years & 12-15 years <50
kg :
loading : 9mg /kg Q12 hrs
for 2 doses
maintenance : 8mg/kg q
12hrs
>50 kg & 15-18 years :
loading :
6 mg /kg Q12 hrs for 2
doses
maintenance : 4 mg/kg Q
12hrs
Normal Dose Normal Dose Normal Dose Normal Dose Normal Dose Normal Dose
Zovirax 1month -11years :
10-20 mg / kg / dose
Q 8hrs
12-17 years :
5-10 mg /kg /dose Q 8hrs
Administer dose
Q 12 hr
Administer dose
Q 24 hr
Administer 50 %
of dose Q 24 hr
Administer 50 %
of dose Q 24 hr
Administer 50 % of
dose Q 24 hr
After dialysis
CVVH: 10 mg /kg Q
24hrs
CVVHD / CVVHDF :
10MG/KG Q 12-24 hr
Zyvox 1 month -12 years :
10 mg/kg
(max:600 mg) Q 8 hrs
12-18 years :
600 mg Q 12 hrs
Normal Dose Normal Dose Normal Dose 10 mg/kg/dose Q
12 hrs
10 mg/kg/dose Q
12 hrs
Normal Dose
References-
BNF, 2015-2016 - Lexicomp online - Drug Prescribing in Renal Failure – uptodate