Pediatric formulary

Oral Antibiotics

Antihistamines

Croup

Parenteral Antibiotics

Decongestants

Anticonvulsants

Antipyretics

Asthma

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).

Preface  ·  Administrative Section  ·  Clinical Section

The General Medical Officer Manual , NAVMEDPUB 5134, January 1, 2000
Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300

This web version of The General Medical Officer Manual, NAVMEDPUB 5134 is provided by The Brookside Associates Medical Education Division.  It contains original contents from the official US Navy version, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense. All material in this version is unclassified. This formatting © 2006 Medical Education Division, Brookside Associates, Ltd. All rights reserved.

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