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Paediatrics drug doses
rationale of antibiotics
Dr. Harishchandra y. v.

 Pediatric drug doses
 Drug combinations
 Choice & rationale of antibiotic therapy

 Drugs play a vital role in protecting,
maintaining and restoring the health of
people, if used rationally.
 Most drugs are chemicals and their
indiscriminate consumption may lead to
toxicity and adverse reactions

Principles of prescribing drugs
i There should be a genuine indication for the use
of a drug in the patient.
ii A minimum number of appropriate, familiar, and
inexpensive drugs of good quality should be
used.
iii Drugs should preferably be prescribed by
generic name.
iv The dosage of the drug should be optimum to
achieve the desired clinical benefits.
v It is desirable to administer drugs as far as
possible through oral route in children

Drug dosages
 Non-Narcotic Analgesics
 Aspirin. Anti-inflammatory dose in rheumatic disease
~ 90-130 mg/kg/D PO q 4 h.
 Antipyretic dose: 30-60mg/kg/ q 4-6 h.
 Salicylates should be avoided on empty stomach.
Side-effects. Hypersensitivity, hypo-
thrombocytopenia. salicylate use and Reye' s
encephalopathy.
 Therefore, use for upper respiratory tract infection
and fevers undetermined origin in children is not
advisable.

 . Combination of antibiotic agents may be
necessary when the causative agent is not
known

 Multidrug therapy is indicated to prevent
bacterial resistance to individual drugs during
long-term management of tuberculosis and
leprosy and also to reduce toxicity of
individual drugs.
 Bactericidal drugs ordinarily act best when
the organism is actively multiplying.
Therefore, bacteriostatic drugs are not the
best agents to combine with bactericidal
drugs.

 Examples of true synergism are rare;
the most notable exception being
co-trimoxazole
incorporating trimethoprim and
sulphamethoxazole.

 ParacetamoI.15mg/kg/dose, every 5-6hours.if
fever is more than 100*f. tepid sponging
40-60 mg/kg/D PO q 4-6 h
.Inj 5 mg/kg 1M.
Side-effects. Skin rashes, hepatotoxicity.
Occasionally renal damage.
 Ibuprofen. 20-30 mg/kg/ day q 6-8 h oral
Avoid infants <6 months age. Side-effects.
Nausea, vomiting rashes.
 Nimesulide. 5 mg/kg/D q 8-12 h.
Side effects.Hepatic enzyme elevation. Use
with caution ; hepatocellular disease or when
combining with anothe hepatotoxic drug. Safety
not established in children und 6 mo of age.

Narcotic Analgesics (Opioids)
 Fentanyl. 0.5-5 kg/kg/dose q 1-4 h IV, as a
continuous infusion 1-5kg/ kg/h. Potent,narcotic
analgesic, 0.1 mg dose possesses an
equivalent analgesic activity to 10 mg of
morphine.
 Pentazocine. 0.5 to I mg/kg per dose 4 times a
day
(30-60 mg 1M equivalent to 10 mg of morphine.
Orally 5 mg equals 60 mg of codeine).
Contraindications Hepatic injury, raised
intracranial tension, porphyria.
 Codeine. For pain: 3 mg /kg/D PO q 4 h. For
cough 0.2 mg/kg/ dose 4 hourly.
 Pethidine. 1-2 mg/kg/dose 1M or IV

IN H.PYLORI
 I. Omeprazole+ amoxicillin+ clarithromycin
 2.Omeprazole+ Amoxycillin + Metronidazole
 3. Omeprazole+ Clarithromycin +
Metronidazole

Amikacin = 15mg/kg/day 2div im/ iv
Asprin = 40- 65mg/kg/day 4 div
rheumatic 65-120mg/kg/day 4div
Ampicillin=mod.inf.100mg/kg/day4divim/iv
sev.inf. 200mg/kg/day
Ampicillin+sulbactum = 50-100mg/kg/day
3div iv over 30minute

Amoxicillin = 40-50mg/kg/day 2div
in areas of resistance 70-80mg/kg
Neonate 20-40mg/kg/day in 3div
amox+clavulinic acid = 25+5mg/kg/24 iv 3div
Adrenaline = 0.01mg/kg/dose sc
Artemether 1.6mg/kg twice/dayim followed by
1.6/kg od x5days

Azithromycin 10mg/kg/dayx 5days
10mg/kg day one
5mg/kg 2 to 5days
Aminophyllin 5mg/kg/dose stat
1-2mg/kg/dose 3times maintenance
Atarax hydroxyzine 0.5/kg/day

KILOGRAMS METER SQUARE
10/KG HALF M 2
20/KG ¾ M 2
30/KG 1 M 2
60/KG 1.7 M 2

 To calculate amount of infusion.
 1ML = 15-16 macro drops
 1ml = 60 micro drops
Amount of ml x 60
_____________________________
No of hours x 60
= micro drops/ minute

Amount of ml x 16
_______________________________
No of hours x 60
= macro drops/ minute

drugs, iv fluids, how
to give new drugs

 One fluid ounce = 28ml
 1 ounce = 28.3495231 grams

Weight / Height
 3months –12months age months + 9
2
 1 years—6years age in years x(2+8)
 7 years—14 years age in years x(7-5)
2
 1year 75cms
 2—12years age in years x +77

New drug in cardiac failure
Levosimendan is a inodilator may be useful in
refractory cardiac failure, refractory pulmonary
hypertension and dilated cardio myopathy.
a pyridazone dinitrile derivative.
Two actions –
enhance cardiac contractility (calcium sensitization.)

causes venous , arterial and coronary
vasodilation , probably by opening
ATP-sensitive potassium channels in
smooth muscle.
Levosimendan may help in decreasing
the need for long term inotropic support
and act as a bridge to heart transplant .
Levosimendan with its long half-life
appears to be a promising ‘once a
week’ inotrope.

tamiflu
 The liquid form dosage also varies as per the
body weight.

A dose of 60 milligram of Tamiflu medicine is
given to those whose body weight is
between 23 and 40 kg,
while a 45 milligram dose is given to children
between 15 kg and 23 kg.
A 30 milligram dose is given to those whose
body weight is below 15 kg.

SITE OF INJECTION
It varies according to the age of the recipient and
the vaccine/drug effect may be
enhanced/diminished.
 All complications of nerve injury and muscle
contracture of injection are also site dependant.
 The preferred site for injections in pediatric
patients are anterolateral aspect of thigh and
the deltoid region.

 Vaccines should never be given in the gluteal
region, as gluteal fat retards absorption.
The preferred site for 1M injection in children.
the target muscle is Vastus Lateralis.
The injection is given on anterolateral aspect of
thigh, middle third portion between greater
trochanter and lateral femoral condyle.

Subcutaneous Injections
Subcutaneous injections are usually
administered into the thigh of infants and in
the deltoid area of older children and adults.
A 5.8- to 3.4” 25- to 26/27- gauge needle
should be inserted into the tissues below the
dermal layer of the skin.

Intramuscular Injections
.The preferred sites for intramuscular injections
are the anterolateral aspect of the upper thigh
and the deltoid muscle of the upper arm.
• The anterolateral gluteal area should not be
used routinely for active vaccination of
infants, children or adults because of the
potential risk of injury to the sciatic nerve.

Hand washing
--is an important prerequisite for
administration of safe injections.
 Effective hand washing technique involves
three stages; preparation, washing and
rinsing & drying.
 Preparation requires wetting hands under
tepid running water before applying liquid
soap or an antimicrobial preparation.
 The hand wash solution must come in
contact with all the surfaces of the hand.

 The hands must be rubbed together vigorously for
a minimum of 10-15 seconds, paying particular
attention to the tips of the fingers, the thumbs and
the areas between the fingers.
 Hands should be rinsed thoroughly .
 Dab the hands prior to drying with pre-sterilized
and clean towels or allowed to air dry.
 Apply an emollient hand cream regularly to protect
skin from the drying effects of regular hand
decontamination.

 If swabs are used to clean the skin they
should be used in an inside out semicircular
movement or, top to bottom without returning
to the site. In most cases though the recipient
may be asked to wash the site prior to
injecting.
 If alcohol is used for cleaning, it should be
allowed to dry before injection is given.
 The site of injection is cleansed in a circular
outward motion with a clean cotton swab
dipped in alcohol.
 The site is allowed to dry before injecting .
 If alcohol is not available soap & water may
be used.

DELTOID MUSCLE
This is the alternate site for children above 3years.
The injection is given 3-5 cm below the acromion
process or midway between acromion process
and deltoid insertion.
The muscle space is adequate for low volume'
injections. If not positioned properly there) is a
potential , for injury to axillary and radial nerves
and posterior circumflex humeral vessels.
Triceps muscle should never be used since radial,
brachial and ulnar nerves and profunda brachii
artery are under the muscle.

POSITIONING
 This is important to ensure that the pain is
less and also there is no injury to the provider
and the patient.
 Thigh: Child may be laid supine or be held
on adult's (mother's) lap.
 Deltoid: Child may be held on adult's lap.
The part should be completely exposed and the
child positioned such that the target muscle is
fully relaxed.

 Sizeofneedles recommended as per lAP ACIP
guidelines .
1M Injection:
23Gx25mm--most children
26Gx16mm—pre-term and small babies
23Gx38mm—obese child.
Subcutaneous-- 23 x 25mm
Intradermal-26/27Gx16mm

 There is no need to aspirate before injecting in
immunization. The vaccine should be injected at a
moderate rate of around 1 mil 1 0 see.

 Toddlers and Older Children: The deltoid may be
used if the muscle mass is adequate. The needle
size 22 to 25 gauge and from 5/8 to 11/4 inches,
based on the size of the muscle. As with infants, the
anterolateral thigh may be used, but the needle
should be longer- generally ranging from 7/8 to 11/4
inches.
 Adults: The deltoid is recommended for routine
intramuscular vaccination among adults, particularly
for Hepatitis B vaccine. The suggested needle size
is 23G x 1 ".

POST INJECTION PRECAUTIONS
 After emptying medication wait for 10
seconds before withdrawing next time.
Withdraw the needle with a smooth and
steady movement. Apply gentle pressure with
a gauze for a few seconds.
 Do not rub the area for site cleaning and
post injection. Do not use alcohol/spirit swab
which may cause burning sensation.

MULTIPLE INJECTIONS
 Use separate syringe and needle for each injection:
If more than one preparation is administered or if
vaccine and an immunoglobulin preparation are
administered simultaneously, it is preferable to
administer each at a different anatomic site.
 It is also preferable to avoid administering two
intramuscular injections in the same limb, especially if
DPT is one of the products administered.
 However, if more than one injection must be
administered in a single limb, the anterolateral aspect
of thigh is usually the preferred site because of the
greater muscle mass; the injections should be
sufficiently separated (i.e., 1-2 inches apart) so that any
local reactions are unlikely to overlap.

POST INJECTION:
 The child should be observed for 15 minutes.
The recipient should be explained to look out
for complication, both immediately and 2-4
hours later if possible. Instruct parents
regarding self management of minor
reactions and to report if any major problem
arises.

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Paediatrics drug doses.ppt

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