Medications: PICU Handbook

Provider Education

May 20, 2022

Antibiotics

DRUG NAME	DOSE	FREQUENCY	MAX DOSE	COMMENTS
Acyclovir	20 mg/kg/dose 10-15 mg/kg/dose	Q 8 hrs		20 mg/kg/dose for 3 mos-12yr 10-15mg/kg/dose for >12 yr
Ampicillin	100-400 mg/kg/day	÷ Q 6 hr	2 gm/dose
Amp/Sulbactam (Unasyn)	100-300 mg/kg/day	÷ Q 6 hr	2 gm/dose Amp	Express as Ampicillin component
Abelcet	5 mg/kg/day	Daily		Liposomal ampho B
Caspofungin	50-70 mg/m2
Cefazolin	20-25 mg/kg/dose	Q 8 hr	1 gm/dose
Cefepime	50 mg/kg/dose	Q 8 hr Q 12 meningitis/CF	2 gm/dose
Ceftriaxone	50-100 mg/kg/day	Daily or ÷ Q 12 hr	2 gm/dose	100 mg/kg/d ÷ Q 12 hr for meningitis
Clindamycin	10 mg/kg/dose	Q 8 hr or Q 6 hr	900 mg Q 8
Fluconazole	6-12 mg/kg/day 3-6 mg/kg/day	Daily		High dose for disseminated infections (12mg/kg/d)
Gentamicin	2.5 mg/kg/dose	Q 8 hr or Q 12 hr Or based on troughs		Q 8 hr for normal kidneys, Q 12 if < 1 mos Dose per trough for renal failure
Meropenem	20 mg/kg/dose	Q 8 hr	1 gm/dose	Adjust for renal failure
Metronidazole	30 mg/kg/day	÷ Q 6 hr		PO is best route if able
Nafcillin	50-200 mg/kg/day	÷ Q 6 hr	2 gm/dose	Better if used centrally
Pip-Tazobactam (Zosyn)	50-75 mg/kg/dose	Q 6 hr	4 gm Piperacillin	Express as Piperacillin component
Vancomycin	15 mg/kg/dose	Q 6, 8 ,12 hrs or by troughs	1 gm/dose	Q 8 hr normal kidneys, Q 6 hr meningitis, Q 12 hr if < 1 month, Per trough for renal failure

Cardiac Patients
Atropine	0.02 mg/kg/dose (1 cc, infants)
Fentanyl	2.5-5 mcg/kg/dose (May cause chest wall rigidity)
Rocuronium	1 mg/kg/dose
High ICPs
Lidocaine	1 mg/kg/dose
Etomidate	0.1-0.3 mg/kg
Rocuronium	1 mg/kg/dose
Asthma
Ketamine	1-2 mg/kg/dose (Bronchodilator, raises SVR)
Atropine	0.02mg/kg/dose
Rocuronium	1 mg/kg/dose
Respiratory Failure (Not Asthma)
Propofol	1-2 mg/kg/dose
Atropine	0.02 mg/kg/dose
Rocuronium	1 mg/kg/dose
Sepsis
Ketamine	1-2 mg/kg/dose (raises SVR)
Rocuronium	1 mg/kg/dose
**Avoid Etomidate (cortisol suppression) and Propofol (hypotension)

Above are general guidelines for RSI. Decision should be made based on provider preference.

Ativan	0.05-0.1 mg/kg/dose, max 2-4 mg
Dexmedetomidine	0.5 mcg/kg bolus over 10 min, then 0.25-1 mcg/kg/hr
Fentanyl	1-2 mcg/kg/dose
Methadone	0.05 -0.2 mg/kg/day PO Q12hr, dose based on prior narcotics
Propofol	0.5-1 mg/kg/dose boluses, 25-100 mcg/kg/min for most infusions
Rocuronium	1 mg/kg/dose (max blockade <5 mins)
Vecuronium	0.1 mg/kg/dose
Versed	0.05-0.1 mg/kg/dose, max 2-4 mg

Famotidine	0.5mg/kg/dose IV/PO BID, max 20 mg BID
Omeprazole	1-3 mg/kg/day PO divided BID or daily
Pantoprazole	1-3 mg/kg/day IV divided BID
Reglan	0.1 mg/kg/dose IV
Ursodiol	10-15 mg/kg/day PO

5 % Albumin	5-10 cc/kg IV (hypotension, volume replacement)
25% Albumin	1 g/kg IV over 60 min (for hypoalbuminemia)
NaHCO3	1-2 meq/kg IV over 20-30 min (central line)
Chlorothiazide	5-10 mg/kg/dose PO/IV Q 12 hr
D10W & D 25W	2 cc/kg IV push
Diamox	5 mg/kg/dose IV Q 12 hr
Furosemide	1 mg/kg/dose IV Q 6 to Q 12 hrs Infusion rates 0.1-0.4 mg/kg/hr
Metolozone	0.2-0.4 mg/kg/day
NS Bolus	10-20 cc/kg over 30-60 min
Spironolactone	1 mg/kg/dose PO Q 12 hr
THAM	3 cc/kg IV (equivalent to 1 meq/kg Bicarb)

Ca Chloride	20 mg/kg IV (must be central line, for iCa <4)
Captopril	0.25-1 mg/kg/dose Q 8 hr (test dose 0.1mg/kg)
Digoxin	5 mcg/kg/dose PO Q 12 hr
Enalapril	0.1-0.4 mg/kg/day divided BID (start w/ low dose)
Epinephrine	0.1 cc/kg of 1:10,000 IV
KCl	0.5-1 meq/kg/dose, max 20 meq
Mg Sulfate	25 mg/kg/dose IV Q 6 hr X 3 dose (for Mg < 2)

Aspirin	5 mg/kg/day (anti-plt effect for shunts)
Enoxaparin	1.5 mg/kg/dose BID for clot tx, daily for prophylaxis
Factor VIIa	90 mcg/kg/dose, may repeat Q 2-3 hrs X 3 doses prn
FFP	10cc/kg IV over 1 hr
IVIG	1 g/kg IV over 3-4 hrs
pRBCs	10-15 cc/kg IV over 2-3 hr (unless Hgb < 5-6)
Vit K	1 mg IM infants, Adults 10 mg IM

Dilantin	15-20 mg/kg IV load, then 3-6 mg/kg/day PO/IV divided BID or TID
Keppra	10 mg/kg/dose PO/IV BID, adolescent 500 mg BID
Mannitol	0.5-1 g/kg/dose IV
3% NaCl	3 cc/kg/dose IV over 30 min for high ICPs
Phenobarbital	15-20 mg/kg IV load, then 4-6 mg/kg/day PO/IV divided Q 12