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General Medical Officer (GMO) Manual: Clinical Section
Pediatric Formulary
Department of the Navy
Bureau of Medicine and Surgery
Antibiotics
Oral
|
Name |
Dosage |
Common
Preparations |
Comments |
Indications |
|
Amoxicillin |
40mg/kg/day
divided TID, may give with food
|
Susp250/5cc
Chew 125mg
Tabs 250mg |
Side effects:
papular rash,
diarrhea, candidiasis |
1st line for
otitis media and sinusitis |
|
Augmentin (Amoxicillin/Clavulanate) |
45 mg/kg/day
divided TID, may give with food
|
Susp250/5cc
Chew125mg
Tabs 250mg |
Side effects:
diarrhea (more than amoxicillin), papular rash, candidiasis |
2nd line for
otitis media
pneumonia
sinusitis |
|
Pediazole (Erythromycin/Sulfisoxazole) |
50 mg/kg/day
divided TID, may give with or without food |
Susp: E-mycin
200mg /
Sulf 600mg / 5cc |
Not
recommended under 2 months of age. Do not give in those with G6PD deficiency |
2nd line for
otitis media
pneumonia
sinusitis |
|
Erythromycin |
40 mg/kg/day
divided TID or QID, give after food
|
Susp
200mg/5cc
Tabs 250mg |
Side effects:
GI upset (32 %), rash. Interacts with tegretol, hismanol, seldane, theophylline |
Respiratory,
skin, and soft tissue infections |
|
Septra,
Bactrim
(Trimethoprim /Sulfamethoxazole)
|
8 mg/kg/day
divided BID (based upon Trimeth)
|
Susp. 40mg
TMP/ 5cc
Tabs 80mg TMP or 160mg TMP |
Not
recommended under 2 months of age
Not in G6PD deficiency
Side effects: rash |
1st line for
UTI
2nd line otitis media
|
|
Suprax
(Cefixime)
|
8 mg/kg/day
QD |
Susp100mg/5cc
Tab200mg,
400mg |
Not
recommended under 6 months of age
Side effects: diarrhea |
2nd line
otitis media
Sinusitis
Pneumonia |
|
Dicloxacillin |
40 mg/kg/day
divided QID |
Susp 62.5/5cc
Caps 125mg, 250mg, 500mg |
Foul-tasting
suspension
Side effects: rash
Give 1 hour before or 2 hours after meals
|
1st line
Impetigo,
Cellultis |
|
Keflex
(Cephalexin)
|
50 mg/kg/day
divided Q6 – Q 12 hours, Give on an empty stomach |
Susp125mg/5cc
Caps250mg,
500 mg
|
Good tasting
suspension
Side effects: rash, nausea |
Skin,
respiratory, and GU infections |
|
Zithromax
(Azithromycin)
|
Pneumonia:
10 mg/kg (max 500mg/day) for first day, then 5 mg/kg (max 250mg/day) for days 2 through 5,
Pharyngitis: 12 mg/kg (max 500mg/day) once daily for 5 days. |
Susp
100mg/5cc,
200mg/5cc
|
Not
recommended under 6 months (pneumonia) or under 2 years (pharyngitis).
Take 1 hour before or 2 hours after meals.
Side effects: GI upset |
Community-acquired
pneumonia, pharyngitis |
Parenteral
|
Name |
Dosage |
Comments |
Indications |
|
Bicillin
C-R 900/300 (Pen G) |
25,000–50,000
units/kg of benzathine deep IM only, max 1.2 million units. Do not give IV. |
Side effects:
rash, superinfection |
Single dose
for Group A Streptococcal infections |
|
Claforan
(Cefotaxime) |
100-200
mg/kg/24h divided q6h-q8h, IV, IM
max 12 g/day |
Side effects:
local or hypersensitivity reactions, diarrhea, rash. |
Meningitis
Sepsis |
|
Rocephin
(Ceftriaxone) |
50-100
mg/kg/24h IV, IM
100mg/kg/24h divided q12h for meningitis
max 4 g/day |
Displaces
bilirubin from albumin
Side effects: diarrhea, rash, superinfection, sludging in gall bladder |
Meningitis
Sepsis |
|
Zinacef
(Cefuroxime) |
75-150
mg/kg/24h divided q8h, IV, IM
max 6g/day |
Side effects:
GI upset, rash |
Pneumonia,
sinusitis, not recommended for meningitis |
Antipyretics
|
Name |
Dose |
Common
Preparations |
Indications |
|
Tylenol
(Acetaminophen ) |
10-15 mg/kg per dose q4h
PO/PR prn |
Drops 80mg / 0.8cc
Elixir160mg / 5cc
Chew 80mg
Caplet 160mg
Tabs325mg and 500mg |
Fever,
pain |
|
Motrin
(Ibuprofen) |
10 mg/kg per dose QID
max 40mg/kg/day.
Not recommended under 6 months
May give with food |
Susp100mg/5mL
Tabs 200, 400, 600, 800mg |
Fever,
pain |
Antihistamines
|
Name |
Dose |
Common Preparations |
Comments |
Indications |
|
Benadryl
(Diphenhydramine) |
5 mg/kg/day
divided QID |
Elixir
12.5mg/5cc
Caps 25/50mg
Tabs 50mg |
Side effects:
drowsiness. |
Urticaria
Pruritis
Eczema
|
|
Atarax
(Hydroxyzine) |
2 mg/kg/day
divided TID, QID |
Syrup
10mg/5cc
Tabs 10 / 25 /100mg |
Side effects:
dry mouth, drowsiness |
Same as
Benadryl |
Decongestants
|
Name |
Dosage |
Comments |
Indications |
|
Dimetapp
(Brompheniramine and phenylpropanolamine)
|
1-6 months: 1.25 ml TID, QID
7-24
months: 2.5 ml TID, QID
2 to 4 years: 3.74 ml TID, QID
4 to 12 years: 5 ml TID, QID
>12 years: 5-10 ml TID, QID,
or 1 tab BID
|
DM preparations
antitussive
Side effects: drowsiness to excitability, nausea |
Rhinorrhea,
nasal congestion |
|
Sudafed
(Pseudoephedrine HCl)
|
< 2 years: 4
mg/kg/day divided QID
2-5 years: 15 mg QID
6-12 years: 30 mg QID
>12 years: 60 mg QID
Give with liquids,
max dose 240 mg/ 24 hours
|
Decongestant,
sympathomimetic
Side effects: tachycardia, nausea, excitability
|
Nasal congestion |
Respiratory Distress
Asthma
|
Name |
Common Preparations |
Dosage |
Comments |
|
Albuterol
(Ventolin, Proventil) |
Syrup:
2 mg/5cc
Nebulizer solution: 5 mg/cc
Metered Dose Inhaler (MDI):
90 mcg/puff |
Syrup:
0.1mg/kg divided TID
Nebulized solution: 2.5-5 mg/3cc
of normal saline every 20 minutes x 3 doses then reassess, do peak flow
MDI with spacer: 2 puffs QID and prior to exercise as needed;
4 to 8 puffs every 20 minutes if in acute bronchospasm
|
Drug of
choice for acute bronchospasm
Under 2 years not recommended
Side effects: tachycardia, agitation, tremor
Excessive or prolonged use can lead to tolerance
|
|
Epinephrine |
1 mg/ ml =
(1:1000)
5 mg/ml = (1:200) |
0.01mg/kg up
to 0.5 mg
every 20 minutes
x 3 subcutaneous in ER setting |
Side
effects: tachycardia, anxiety, hypertension, tremor |
|
Corticosteroids
(prednisone, prednisolone - Pediapred,
methylprednisolone) |
Prednisone - Oral: 2.5
mg, 5 mg, 10 mg,
20 mg, 50 mg,
Prednisolone – Oral solution: 5 mg/5 cc
Methyprednisolone – Oral: 2mg,
4mg, 8 mg, 16 mg, 32 mg
Other preparations include IV, IM, MDI |
Oral:
short course "burst": 1-2 mg/kg/day PO (max 60 mg/day) for 3 to 10 days
IV: 1 mg/kg IV every 6 hours for 48 hour hospitalization |
With chronic
use: Cushing’s Syndrome, peptic ulcer disease, acne
|
|
Intal
(Cromolyn Sodium) |
Nebulizer
solution: 20 mg/2 cc ampule
MDI: 0.8 mg/puff |
Nebulized
solution: 20 mg QID,
under 2 years of age not recommended;
MDI: 2 puffs QID,
not recommended under 5 years of age
|
Mast cell
stabilizer without any bronchodilating effect, only used only for
prophylaxis
|
Croup
|
Name |
Dosage |
Comments |
|
Racemic Epinephrine
(Vaponefrin) |
0.25-0.75 ml of 2.25%
racemic epinephrine solution in 2.5 ml
saline via nebulizer every 2 hours as needed |
Rebound stridor very
common
Observe 12-24 hrs after use
Side effects: tachycardia, anxiety, hypertension |
|
See
Corticosteroids above |
Anticonvulsant treatment for ongoing seizure activity
|
Name |
Preparations |
Dosage |
Comments |
|
Lorazepam
(Ativan) |
2 mg/ml
4 mg/ml |
0.05-0.10
mg/kg IV over 2-5 minutes IV every
10 to 15 minutes, max dose = 4mg/kg.
Same dose may be given PR or sublingually if no IV access.
|
Benzodiazepine,
anticonvulsant, sedative, anti-anxiety, hypnotic.
Side effects: respiratory depression, confusion. |
|
Diazepam
(Valium) |
5 mg/ml |
0.2-0.3
mg/kg/dose IV every 2-5 minutes.
PR: 0.5 mg/kg/dose
max dose = 1-2 mg/minute IV push. |
Benzodiazepine,
anticonvulsant, sedative, anti-anxiety, hypnotic. Interacts with other CNS depressants,
tagamet, erythromycin, valproic acid
Side effects: respiratory depression, drowsiness, and confusion. |
|
Versed
(Midazolam) |
1 mg/ml
5 mg/ml |
0.2 mg/kg IM
0.15 mg/kg IV
Although IV versed has no advantage over valium or ativan, it is efficacious as an IM anticonvulsant when IV or
IO access is not available. Currently, versed is the only anticonvulsant with a
rapid onset of action
that can be safely given as either IV or IM. |
Benzodiazepine,
anticonvulsant, sedative, hypnotic. Interacts with other CNS depressants, tagamet,
erythromycin, rifampin, theophylline.
Side effects: respiratory depression,
sedation, amnesia, nausea. |
|
Phenobarbital |
30 mg/ml
60 mg/ml
65 mg/ml
130 mg/ml |
10-15 mg/kg
IV loading dose; then 3-5 mg/kg/day IV or PO maintenance dose divided QD or BID
(this may vary widely dependent upon age)
Do not exceed 1 mg/kg/minute IV. |
Barbiturate,
anticonvulsant, sedative, hypnotic. Interacts with valproic acid, oral contraceptives,
griseofulvin, theophylline, corticosteroids, and doxycycline.
Side effects: respiratory depression, apnea, hypotension, and
drowsiness. |
|
Dilantin
( Phenytoin) |
50 mg/ml |
15-20 mg/kg
IV loading dose; 5-10 mg/kg/day IV or PO, maintenance dose divided BID, TID.
Do not exceed 1-3 mg/kg/min IV, max 50mg/min IV.
IV flushes should be followed by normal saline flushes. Need telemetry monitoring
|
Anticonvulsant,
antiarrythmic
Interacts with valproic acid, oral contraceptives, rifampin,
theophylline, corticosteroids, sulfonamides, and doxycycline. Side effects: rhythm
disturbances, hypotension, nausea, slurred speech, ataxia
|
Revised by CDR Wendy Bailey, MC, USN, Pediatrics Specialty Leader, Naval
Medical Center San Diego, San Diego, CA (1999). Reviewed by CAPT Robert Wilkins,
MSC, USN, Pharmacology Specialty Leader, Bureau of Medicine and Surgery, Washington, D.C.
(1999).
Approved for public release; Distribution is unlimited.
The listing of any non-Federal product in this CD is not an
endorsement of the product itself, but simply an acknowledgement of the source.
Operational Medicine 2001
Health Care in Military Settings
Bureau of Medicine and
Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
20372-5300 |
Operational
Medicine
Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
January 1, 2001 |
United States Special Operations Command
7701 Tampa Point Blvd.
MacDill AFB, Florida
33621-5323 |
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