Common meds

• 60 mg/kg/day IV divided q 8 h x 14-21 days - infuse over 1 h 

• 20 mg/kg/dose q 24h in AKI infants 

GA ≤ 34 weeks 

• ≤ 7 days: 100 mg/kg/day div q12hr 

• 8 – 28 days: 150 mg/kg/day div q12h 

• ≥ 29 days: 200 mg/kg/day div q6h (max 8 g/day) 

GA >34 weeks 

• ≤ 7 days: 150 mg/kg/day div q8hr 

• > 7 days: 200 mg/kg/day div q6hr (max 8 g/day) 

Meningitis Dosing 

• ≤ 7 days: 200 – 300 mg/kg/day div q8hr 

• 8 – 28 days: 300 mg/kg/day div q6hr 

• ≥ 29 days: 300 – 400 mg/kg/day div q4 – 6 hr (max dose 12 g/day) 

Prophylaxis for urinary tract abnormality 

• 30-50 mg/kg/dose PO q 24 h (or use amoxicillin) 

• Remember, even 200 mg/kg is a "meningitic dose;" avoid the use of the term "septic dose." 

GA <36 weeks (≤ 2 kg): 

• ≤28 days: 30 mg/kg/dose IV q12hr 

• ≥ 29 days: 50 mg/kg/dose IV q8hr 

GA ≥ 36 weeks (> 2 kg): 

• ≤28 days: 50 mg/kg/dose IV q12hr 

• ≥ 29 days: 50 mg/kg/dose IV q8hr 

GA < 32 weeks

• < 14 days: 100 mg/kg/day div q12hr 

• ≥ 14 days: 150 mg/kg/day div q8hr 

GA ≥ 32 weeks

• ≤ 7 days: 100 mg/kg/day div q12hr 

• > 7 days: 150 mg/kg/day div q8hr 

Meningitis

• ≤ 7 days: 100 -150 mg/kg/day div q8-12hr 

• > 7 days: 150 mg/kg/day div q8hr 

GA ≤ 29 weeks

• ≤ 14 days: 5 mg/kg/dose q48hr 

• 15 – 28 days: 5 mg/kg/dose q36hr 

• ≥ 29 days: 5 mg/kg/dose q24hr 

GA 30 – 34 weeks

• ≤ 14 days: 5 mg/kg/dose q36hr 

• ≥ 15 day: 5 mg/kg/dose q24hr 

GA ≥ 35 weeks

• ≤ 7 days: 4 mg/kg/dose q24hr 

• ≥ 8 days: 5 mg/kg/dose q24hr 

HIE/Cooling

• 5 mg/kg/dose q36hr 

GENTAMICIN LEVELS

Peak: 

• 5-10 microgram/mL is acceptable. 

Trough: 

• After the second dose for most infants being treated more than 48 h

• After 24 h for infants with severe infections, asphyxia, PDA, or renal failure. 

• If a 24-hour trough is done, choose the next dosing interval as follows: 

  • 24-Hour Trough Dosing Interval: 

  • < 1: q24h 

  • 1.1-2.3: q36h 

  • 2.4-3.2: q48h 

  • > 3: check level before each dose 

• For gentamicin toxicity, give ticarcillin (deactivates gentamicin) 

CGA ≤ 34 weeks

• 7.5 mg/kg/dose q12hr

CGA 34 – 40 weeks

• 7.5 mg/kg/dose q8hr

CGA > 40 weeks

• 10 mg/kg/dose q8hr

GA ≤ 34 weeks

• ≤ 7 days: 50 mg/kg/day div q12hr

• 8 – 28 days: 75 mg/kg/day div q8hr

• ≥ 29 days: 150 mg/kg/day div q6hr (max 12 g/day)

GA >34 weeks

• ≤ 7 days: 75 mg/kg/day div q8hr

• 8-28 days: 100 mg/kg/day div q6hr

• ≥ 29 days: 150 mg/kg/day div q6hr (max 12 g/day)