Pediatric Terrorism and Disaster Preparedness: Table 6.7

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Pediatric Terrorism and Disaster Preparedness

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Table 6.8. Antibiotics for Treatment of Post-Radiation Neutropenia

Choice	Antimicrobial	Dosage and Route	Comments and Spectrum of Activity
First-choice antimicrobials (listed in order of potential efficacy)	Cefepime	150 mg/kg divided q 8 h, IV or IM	Not available in oral form. Activity against gram-positive organisms, except Enterococcus spp. Activity against gram-negative organisms, including Pseudomonas aeruginosa and certain Enterobacteriaceae that generally are resistant to most third-generation cephalosporins.
	Ceftazidime	100-300 mg/kg/day divided q 8 h	May need to add amoxicillin^a or vancomycin^b Not available in oral form. Activity against gram-negative organisms, including Pseudomonas aeruginosa and certain Enterobacteriaceae that generally are resistant to most third-generation cephalosporins.
	Ceftriaxone	50-75 mg/kg/day, IV or IM, once a day	Not available in oral form. Activity against gram-positive organisms, except Enterococcus spp.
Second-choice	Gentamicin	3-7.5 mg/kg/day divided q 8-24 h, IV or IM	May need to add amoxicillin^a or vancomycin^b Not available in oral form.
Second-choice	Amikacin	15-22.5 mg/kg/day divided q 8 h, IV or IM	May need to add amoxicillin^a or vancomycin^b Not available in oral form.
Third-choice	Ciprofloxacin	20-30 mg/kg/day divided q 12 h, PO, IV, or IM	May need to add amoxicillin^a or vancomycin^b Effective against gram-negative organisms and atypical bacteria. Also effective against Pseudomonas species but poor coverage against gram-positive organisms (including Staphylococcus aureus and nonhemolytic streptococci).
	Levofloxacin	10 mg/kg/day, PO, IV, or IM	May need to add amoxicillin^a or vancomycin^b Effective against gram-negative organisms and atypical bacteria. More gram-positive coverage than ciprofloxacin.
	Gatifloxacin	10 mg/kg/day, PO or IV	Expanded spectrum against both gram-negative and gram-positive organisms. Can be administered as single agent.

^a Dosage: 25-50 mg/kg/day divided q 8 h, PO
^b Dosage: 40-60 mg/kg/day divided q 6-8 h, IV

Notes: PO = by mouth; IV = intravenous; IM = intramuscular.

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