Neobook — clinical reference

Note: Pharmacy supply may change

Dosing and administration recommendations for antibiotic and anti-viral therapy

Drug name	Dose	Diluent & Preparation	Infusion rate
Acyclovir Vial = 250mg*	20mg/kg/dose IVI: 8 hourly <34 weeks or renal/hepatic failure: 12 hourly	Sterile water for injection Reconstitute 250mg vial with 10ml sterile water for injection Final concentration: 25mg/ml	60 minutes
*Amikacin Vial = 100mg/2ml (TDM before 3rd dose)	15mg/kg/day IVI	Sterile water for injection Dilution: Draw up 1ml (50mg) from vial, add 4ml sterile water for injection to make a total of 5ml. Final concentration: 10mg/ml	30-60 minutes
*Amphotericin B Vial = 50mg (Fungizone)	1mg/kg/day IVI	5% dextrose NO NaCl Reconstitute 50mg vial with 10ml sterile water shaking vial immediately until solution is clear. Initial concentrate: 5mg/ml Now dilute with 0.2ml (1mg) of above concentrate with 9.8ml 5% dextrose water to final concentration of 0.1mg/ml. Final concentration: 1mg/10ml or 0.1mg/ml	4 hours Slow intravenous infusion
Ampicillin Vial = 500mg* Or 250mg	50-100mg/kg/dose IVI 8 hourly Except: 1st week of life and <2kg: 12 hourly	Sterile water for injection Reconstitute 500mg vial with 5ml sterile water for injection Final Concentration: 100mg/ml OR Reconstitute 250mg vial with 5ml sterile water for injection Final Concentration: 50mg/ml	Slow bolus over 5 minutes
Benzylpenicillin Vial = 5 000 000 IU*	50 000-100 000IU/kg/dose IVI Preterm 1st week of life: 12 hourly >1 week old: 8 hourly Term Any postnatal age: 6 hourly	Sterile water for injection Reconstitute 50 00000 IU vial with 10ml sterile water for injection Final concentration: 500 000IU/ml	30 minutes


Cefepime Vial = 500mg*	50mg/kg/dose 8 hourly IVI	Sterile water for injection Reconstitute 500mg vial with 5ml sterile water for injection Final concentration: 100mg/ml OR Reconstitute 1g with 10ml sterile water for injection Final concentration: 100mg/ml	30 minutes
Cefotaxime Vial = 1g	50-100mg/kg/dose IVI 1st week of life: 12 hourly >1-3 weeks: 8 hourly >3 weeks: 6 hourly	Sterile water for injection Reconstitute 1g vial with 40ml sterile water for injection Final concentration: 25mg/ml	60 minutes



Ceftazidime Vial = 1g*	30-50mg/kg/dose IVI >1-3 weeks: 12 hourly >3 weeks: 8 hourly 50mg/kg/dose if meningitis expected or proven	Sterile water for injection Reconstitute 1g vial with 10ml sterile water for injection Final concentration: 100mg/ml	30 minutes



Ceftriaxone Vial = 1g	75-100mg/kg/day IVI	Sterile water for injection Reconstitute 1g vial with 10ml sterile water for injection Final concentration: 100mg/ml	Slow bolus over 5 minutes
Cloxacillin Vial = 500mg or 250mg	100-150mg/kg/day IVI 1st week of life: 12 hourly > 1-4 weeks: 8 hourly	Sterile water for injection Reconstitute 500mg vial with 10ml sterile water for injection Final concentration: 50mg/ml OR Reconstitute 250mg vial with 5ml sterile water for injection Final concentration: 50mg/ml	Slow bolus over 5 minutes


*#Colistin	Loading dose: 118 000 IU/kg IVI Maintenance dose: 74 000 IU/kg 12 hourly IVI	Sterile water for injection Refer to Colistin dosing guideline
Fluconazole 200mg/100ml*	Loading dose: 25mg/kg IVI Maintenance dose: 20mg/kg/day IVI	In solution form for infusion Final concentration: 2mg/ml	30-60 minutes
Gancyclovir Vial = 500mg*	6 mg/kg 12 hourly IVI	Sterile water for injection Reconstitute 500mg vial in 10 ml of sterile water. Initial concentration: 50mg/ml Take 0.2ml of above concentrate (50mg/ml) dilute up to 10mls with 5% dextrose. Final concentration: 10mg/ml Final concentration for infusion should not exceed 10mg/ml.	60 minutes
*Gentamicin Vial = 80mg/2ml (TDM before 3rd dose)	5mg/kg daily IVI	Sterile water for injection Dilute: Draw up 1ml (40mg) from vial, add 3ml sterile water for injection to make a total of 4ml. Final concentration: 10mg/ml	30 minutes
Meropenem Vial = 500mg or 1g*	20 – 40 mg/kg/dose IVI 8 hourly 40mg/kg/dose IVI if meningitis suspected	Sterile water for injection Reconstitute 500mg vial with 10ml sterile water for injection Final concentration: 50mg/ml OR Reconstitute 1g vial with 20ml sterile water for injection Final concentration: 50mg/ml	15-30 minutes
#Micafungin Vial = 50mg or 100mg	Loading dose: 15mg/kg IVI Maintenance: 10mg/kg/day IVI	5% dextrose Reconstitute vial with 5% dextrose. For a 50mg vial reconstitute with 5ml giving a concentration of: 10mg/ml For a 100mg vial reconstitute with 5ml giving a concentration of: 20mg/ml Further dilute above concentrate with 5% dextrose. For 10mg/ml concentrate, dilute up to 10ml. For 20mg/ml concentrate, dilute up to 20ml. Final concentration: 1mg/ml. Reconstituted drug should be further diluted in normal saline or 5% Dextrose to a final concentration between 0.5 to 1.5 mg/mL prior to administration. Diluted infusion should be protected from light and may be stored at room temperature for up to 24 hours before use. An existing IV line should be flushed with normal saline prior to administration.	60 minutes
Piperacillin-tazobactam Vial = 4g/0.5g*	100 mg/kg/dose IVI 8 hourly	Sterile water for injection Reconstitute 4g/0.5g vial with 20ml sterile water for injection Final concentration: 200mg/ml	30 minutes
#Tigecycline Vial = 50mg/5ml	1-2mg/kg/12 hourly IVI Loading dose: 1.5mg/kg If no loading dose: 2mg/kg/12 hourly	5% Dextrose injection 5.3 mL of 0.9% NaCl or 5% Dextrose injection or Lactate Ringer’s solution to achieve a concentration of 10 mg/ml. Once reconstituted, may be stored at room temperature for up to 24 hours.	30 minutes
*Vancomycin Vial=500mg (TDM before 3rd dose)	Loading dose: 25mg/kg IVI Maintenance: 15mg/kg/dose IVI <35 weeks CGA: 12 hourly >35 weeks CGA: 8 hourly	5% dextrose water Reconstitute 500mg vial with 100ml 5% dextrose water Final concentration: 5mg/ml	60 minutes

TDM= therapeutic drug monitoring; *Discuss drug dosing with clinical pharmacology in cases of renal impairment; #Authorization required +/- Section 21

Click here for the pdf

Colistin dosing guideline

Authorization required +/- Section 21

Dose prescribed ≤ 1 000 000

Number of 1 MU vials needed	1
Syringe	10 ml
Sterile water for injection to add to the 10 mL syringe after drawing up the colistin	8 mL
Amount of colistin per mL	100 000 IU/mL
How to calculate the volume needed?	mL to be injected = Dose in units / 100 000

Dose prescribed > 1 000 000 but ≤ 2 000 000

Number of 1 MU vials needed	2
Syringe	10 ml
Sterile water for injection to add to the 10 mL syringe after drawing up the colistin	6 mL
Amount of colistin per mL	200 000 IU/mL
How to calculate the volume needed?	mL to be injected = Dose in units / 200 000

Dose prescribed > 2 000 000 but ≤ 3 000 000

Number of 1 MU vials needed	3
Syringe	10 ml
Sterile water for injection to add to the 10 mL syringe after drawing up the colistin	4 mL
Amount of colistin per mL	300 000 IU/mL
How to calculate the volume needed?	mL to be injected = Dose in units / 300 000

Dose prescribed > 3 000 000 but ≤ 4 000 000

Number of 1 MU vials needed	4
Syringe	10 ml
Sterile water for injection to add to the 10 mL syringe after drawing up the colistin	2 mL
Amount of colistin per mL	400 000 IU/mL
How to calculate the volume needed?	mL to be injected = Dose in units / 400 000

Dose prescribed > 4 000 000 but ≤ 5 000 000

Number of 1 MU vials needed	5
Syringe	10 ml
Sterile water for injection to add to the 10 mL syringe after drawing up the colistin	0 mL
Amount of colistin per mL	500 000 IU/mL
How to calculate the volume needed?	mL to be injected = Dose in units / 500 000

Click here for the pdf

Note:
Multi-dose vials should not be shared between patients as this increases the risk of cross-infection and impedes tracking of antimicrobial use at patient level. Colistin vials in particular cannot be shared, as these are issued with Section 21 approval on a named patient basis.

Tygerberg Hospital Department of Paediatrics: Neonatology - Antimicrobial and Antiviral Drug Table _version 3_08 August 2023

Guidelines for Administration of Commonly used Antibiotics in the Neonatal Unit

Dosing and administration recommendations for antibiotic and anti-viral therapy

Colistin dosing guideline

Drugs mentioned