> 14 days
≤ 28 weeks corrected GA: 20 - 22 mg/kg/dose IV Q18h
29 - 34 weeks corrected GA: 20 - 22 mg/kg/dose IV Q12h
≥ 35 weeks corrected GA: 20 - 22 mg/kg/dose IV Q8-12h
0 - 14 days
≤ 28 weeks GA: 20 - 22 mg/kg/dose IV Q24h
29 – 34 weeks GA: 20 - 22 mg/kg/dose IV Q18h
≥ 35 weeks GA: 20 - 22 mg/kg/dose IV Q12h
Serum Level: PRE level 0 to 30 minutes before dose
Initial Level: Prior to fourth or fifth dose
PRE (Trough) levels:
6 - 10 mg/L: Infections (e.g bacteremia) with coagulase negative staphylococci (e.g. S. epidermidis) including line infections.
10 - 15 mg/L: Skin and soft tissue infections caused by methicillin resistant Staphylococcus aureus (MRSA)
Higher levels or AUC calculations could be considered in other severe infections due to MRSA
POST (Peak): Not routine.
Serum creatinine with PRE level once weekly.
If targeted levels >10 mg/L, consider more frequent monitoring
Patients recieving > 7 days of therapy should have a weekly CBC to assess for neutropenia.
Confirmed infections with coagulase negative staphylococcus species (e.g. S. epidermidis)
Empiric therapy for serious infections potentially due to methicillin-resistant S. aureus (MRSA)
Confirmed infection for methicillin-resistant S. aureus (MRSA)
Empirically for < 48 hours for suspected/confirmed meningitis until cultures available and re-assess
Confirmed infections due to ampicillin-resistant enterococcus
Concentration: 50 mg/mL
Taste: Metallic taste
Not all strengths of oral liquids are listed nor be available on the CHEO Formulary
Tablets or capsules are preferred especially over an unpleasant tasting oral liquid.
Not all strengths of oral tablets/capsules are listed and they are not all available on the CHEO Formulary.