*6.1.4.3.2 Ceftazidime*

Treatment of neonatal meningitis and sepsis caused by susceptible gram-negative organisms (e.g. *E. coli, H. influenze, Neisseria, Klebsiella,* and *Proteus* species), especially *Pseudomonas aeruginosa*. Resistance among strains of *Serratia* and *Enterobacteriaceae* is increasing (Kanmaz, 2010; Young & Mangum, 2010).

*Dose:* 30 mg/kg per dose IV infusion by syringe pump over 30 minutes, or IM. To reduce pain at IM injectione site, ceftazimide may be mixed with 1% lidocaine without epinephrine (Kanmaz, 2010; Young & Mangum, 2010).Newborn; IM-IV <7 days and <2000 g; 100 mg/kg/days every 12 hours, >2000 g; 100 mg/kg/days every 8 hours, >7 days; 100-150 mg/kg/days every 8 hours, for others; 100-150 mg/kg/days (max 6 g) IV-IM every 8 hours (Apak, 1996; Eroğlu, 2002).

*Adverse Effects:* Reported adverse effects are uncommon but include rash, diarrhea, elevated hepatic transminases, eosynophilia, and positive Coombs' test (Kanmaz, 2010; Young & Mangum, 2010).

*Administration and Storage Conditions:* When the drug in powder gets diluted it can be stored for 24 hours under room temperature; and 7 days in refrigerator. It has not been approved to use preparations containing L-Arginine on children. As the forms administered to children contain sodium carbonate it releases carbon dioxide bubbles when diluted (Kanmaz, 2010).

*Incompatible Drugs:* Fluconazole, Midazolam, Vancomycin (Kanmaz, 2010).

#### **6.1.4.4 Fourth-generation cephalosporins**

*6.1.4.4.1 Maxipime* 

Administered at a dose of 50-100 mg vial every 8 hours (Eroğlu, 2002).

### **6.1.5 Aminoglycosides**

They inhibit the protein synthesis ribosomes. They have bactericidal effects on gram (-) enteric bacilli and *S. aureus*. And they are discharged from kidneys. Dose adjustment is important even in minor renal failures (Eroğlu, 2002).

#### **6.1.5.1 Amicacin**

*Uses:* Amicacin belongs to the aminoglycoside family of antibiotics. It has a very broad spectrum of activity. Bactericidal effect on bacteria of the strains of Gram-positive and Gram-negative and are resistant to certain enzymes produced by bacteria - betalactamase. Amicacin bacteria disrupts protein synthesis (Young & Mangum, 2010).


*Side Effects:* Nephrotoxicity, ototoxicity, arthralgia, rash, eosinophil, neuromuscular block may develop (Apak, 1996).

> 1/100- Dizziness, sense of hearing and balance.

1/1000- Fever. Rash and itching. Disturbances in liver function. Changes in the blood picture.

<1/1000- Headache. Lowering blood pressure. Reducing the number of white blood cells, platelet count. Anemia. Tingling. Convulsions. Arthralgia (Young & Mangum, 2010).

*Incompatibility:* Lipid solution, Ampicillin, amphotericin B, phenytoin (Kanmaz, 2010).

#### **6.1.5.2 Gentamicin**

308 Complementary Pediatrics

Newborn; < 7 days: (100 mg/kg/day) 12 hours interval, > 7 days; (150 mg/kg/days) IV-IM 8 hours interval, others; 100-200 mg/kg/days IV-IM 6-8 hours interval, for Meningitis; 200

*Adverse Effects:* neurotoxicity risk increases if used with Aminoglykosides. It may result in hypersensitivity for penicillin sensitive people (Apak, 1996; Eroğlu, 2002). Side effects are rare but include rash, phlebitis, diarrhea, leukopenia, granulocytopenia, and eosinophilia

Treatment of neonatal meningitis and sepsis caused by susceptible gram-negative organisms (e.g. *E. coli, H. influenze, Neisseria, Klebsiella,* and *Proteus* species), especially *Pseudomonas aeruginosa*. Resistance among strains of *Serratia* and *Enterobacteriaceae* is increasing (Kanmaz,

*Dose:* 30 mg/kg per dose IV infusion by syringe pump over 30 minutes, or IM. To reduce pain at IM injectione site, ceftazimide may be mixed with 1% lidocaine without epinephrine (Kanmaz, 2010; Young & Mangum, 2010).Newborn; IM-IV <7 days and <2000 g; 100 mg/kg/days every 12 hours, >2000 g; 100 mg/kg/days every 8 hours, >7 days; 100-150 mg/kg/days every 8 hours, for others; 100-150 mg/kg/days (max 6 g) IV-IM every 8 hours

*Adverse Effects:* Reported adverse effects are uncommon but include rash, diarrhea, elevated hepatic transminases, eosynophilia, and positive Coombs' test (Kanmaz, 2010; Young &

*Administration and Storage Conditions:* When the drug in powder gets diluted it can be stored for 24 hours under room temperature; and 7 days in refrigerator. It has not been approved to use preparations containing L-Arginine on children. As the forms administered to children contain sodium carbonate it releases carbon dioxide bubbles when diluted

They inhibit the protein synthesis ribosomes. They have bactericidal effects on gram (-) enteric bacilli and *S. aureus*. And they are discharged from kidneys. Dose adjustment is

*Uses:* Amicacin belongs to the aminoglycoside family of antibiotics. It has a very broad spectrum of activity. Bactericidal effect on bacteria of the strains of Gram-positive and Gram-negative and are resistant to certain enzymes produced by bacteria - betalactamase.

*Incompatible Drugs:* Fluconazole, Midazolam, Vancomycin (Kanmaz, 2010).

Administered at a dose of 50-100 mg vial every 8 hours (Eroğlu, 2002).

Amicacin bacteria disrupts protein synthesis (Young & Mangum, 2010).

mg/kg/days IV 6 hours interval (Apak, 1996; Eroğlu, 2002; Küçüködük, 1994).

(Young & Mangum, 2010).

2010; Young & Mangum, 2010).

(Apak, 1996; Eroğlu, 2002).

**6.1.4.4 Fourth-generation cephalosporins** 

important even in minor renal failures (Eroğlu, 2002).

Mangum, 2010).

(Kanmaz, 2010).

*6.1.4.4.1 Maxipime* 

**6.1.5.1 Amicacin** 

**6.1.5 Aminoglycosides** 

*6.1.4.3.2 Ceftazidime* 

It is one of the most commonly used aminoglycosides (Krdak & Kilicturgay, 1996; Rang et al, 1998).

Uses: Treatment of infections caused by aerobic gram-negative bacilli (e.g. *Pseudomonas, Klebsiella, E. coli*). Usually used on combination with a B-lactam antibiotic (Young & Mangum, 2010). High serum levels are required for bactericidal effect. Side effects are less seen with longer dose intervals. The volume of distribution increases in patients with PDA and clearance decreases. In premature and asphyxiated infants serum half-life prolongs (Kanmaz, 2010).


*Adverse Effects:* The most frequently reported adverse reactions are occular burning and irritation upon drug instillation, non-specific conjunctivitis, conjunctival epithelial defects, and conjunctival hyperemia.

Other adverse reactions which have occurred rarely are allergic reactions, thrombocytopenic purpura, and hallucinations (Young & Mangum, 2010).

Garamycin, Genta, Gensif, Gentamicin, Gentrex are its derivatives. It has ototoxic and nephrotoxic side effects (Krdak & Klçturgay, 1996; Rang et al, 1998). Temporary tubular dysfunction: loss of calcium, magnesium and sodium via the urinary system. Vestibular and auditory toxicity. When used with patients using pancuronium neuromuscular blockage may increase. In the event that extravasation develops hyaluronidase can be used. Other concomitant ototoxic and nephrotoxic drugs increase the toxicity (Kanmaz, 2010).

The Administration and Dose of Most Frequently Used Drugs in Pediatrics 311

*Side Effects:* 1/100- Rash, pruritus. Protein in the urine, an increase of uric acid in urine. Dizziness and balance disorders. The deterioration of hearing. 1/1000- Changes in blood picture. Urticaria. Changes in the liver. <1/1000- Headache. Anemia. Lowering blood

*Administration and Storage Conditions:* Ampoules should be diluted before use. The drug

*Incompatible Drugs:* Amphotericin B, Ampicillin, Furosemide, Heparin, Methicillin, Mezlocillin, Nafcillin, Oxacillin, Penicillin G, Propofol, Ticarcillin/Clavulanate (Kanmaz,

It inhibits the protein synthesis by binding to ribosome. It can be used with sulphonamide

Uses: Erythromycin is used alternatively instead of penicillin to treat bacterial infections, especially in patients allergic to penicillin. The drug is effective in the treatment of diphtheria treatment of whooping cough, pneumonia caused by Mycoplasma pneumonia (including infants), Legionnaires' disease, the treatment of Chlamydia, Gonorrhea, Syphilis,

Dose: 10 mg/kg PO (Young & Mangum, 2010). While erythromycin estolate should be administered every 3 hours; ethylsuccinate one should be administered every 6 hours with food. In chlamydia treatments: Estolate form 12.5 mg/kg/dose every 6 hours for 14 days. In serious infections 5-10 mg/kg/dose every 6 hours with a slow infusion for 60 min. or 10 mg/kg/dose PO. In ophthalmia neonatorum treatment: 0.5% cream for each conjunctiva

*Side effects:* It is accepted as one of the most dependable antibiotics. The side effects are rarely seen and usually light and limited to skin. However in several occasions angioedema

*Drug Interaction:* The plasma clearance of midazolam decreases by 50%. Theophylline and carbamazepine serum concentration may increase. When used together with sisapride, it

*Monitor:* Heart rate and blood level should be monitored during IV use. Liver function tests

It inhibits bacteria protein synthesis. It has wide-spectrums active against gram (+) and gram (-) bacteria (Behrman & Kliegman, 2001; Eroğlu, 2002). Its use is limited in infants and children because of the side effects. Tetracycline prevents growth accumulating in bones and teeth. It should be used on ones older than 8 years old. It may increase intracranial

endocarditis, urinary tract inflammation, conjunctivitis (Young & Mangum, 2010).

and urticarial have been observed to develop (Gallardo & Thomas, 1999).

should be carried out. Hemogram can be used for eosinophilia (Kanmaz, 2010).

causes serious dysrhythmias (Kanmaz, 2010).

pressure. Kidney damage (Young & Mangum, 2010).

2010).

**6.1.6 Macrolides 6.1.6.1 Erythromycin** 

(Kanmaz, 2010).

**6.1.6.2 tetracyclines** 

pressure in infants (Eroğlu, 2002).

diluted with SF can be stored for 3 days in refrigerator (Kanmaz, 2010).

for otitis media treatment (Eroğlu, 2002; Gallardo & Thomas, 1999).

*Incompatible Drugs:* Amphotericin B, Ampicillin, Furosemide, Heparin (>1 U/ml), Imipenem/Cilastatin, Indomethacin, Methicillin, Mezlocillin, Nafcillin, Oxacillin, Penicillin G, Propofol, Cefepime, Ticarcillin/Clavulanate (Kanmaz, 2010).

#### **6.1.5.3 Streptomycin sulfate**

It is an antibiotic and anti-tuberculostatic drug. It affects some gram negative and positive microorganisms (Kavakl et al, 1998). It is used with Isoniazid and other tuberculosis drugs in tuberculosis meningitis and progressive tuberculosis. In tuberculosis meningitis it is administered by IM route every 12 hours 20-40 mg/kg/day. The maximum dose is 1 g/day. The length of treatment period is usually 2-3 months. Higher doses and/or more prolonged therapy may result to destruction in 8th cranial nerve (Eroğlu, 2002).

*Side effects:* Myocarditis, Ataxia, nuisance, vomiting, ototoxicity, nephrotoxicity and hypersensitivity can be seen (Kavakl et al, 1998).

#### **6.1.5.4 tobramycin**

It is more active against P. Aeruginosa than gentamycin. Newborn; IV (30-60 min.) , IM; <7 days <34 weeks <1500g; 3 mg/kg every 24 hours, >1500g; 2.5 mg/kg every 18 hours, >34 weeks >1500g; 2.5 mg/kg every 12 hours, >after 7 days; 5 mg/kg every 12 hours, for older people; 5-7.5 mg/kg/day IM, IV every 6-8 hours (Eroğlu, 2002; Küçüködük, 1994).

#### **6.1.5.5 Netilmicin**

Treatment of infections caused by aerobic gram-negative bacilli (Young & Mangum, 2010). It is antimicrobial effective and indicated for the treatment of sepsis caused by susceptible E. *coli, Klebsiella, Enterobacter, Pseudomonas, H. influenza, Salmonella, Shigella, Staphylococci* and of respiratory tract and surgical infections. And it is used in the treatment of complicated urinary system infections, sepsis, skin and skin joint infections, lower respiratory infections and intra-abdominal infections (Köksal & Mangum, 2010).

*Uses:* Serious life-threatening infections with bacteria sensitive to Netromycin (sepsis, endocarditis) (Young & Mangum, 2010).

*Dose:* The dose to be used in the first week ≤29 gestational weeks 5 mg/kg/dose every 48

The dose to be used in the first week ≤29 gestational weeks 5 mg/kg/dose every 48 hours

30-33 weeks 4.5 mg/kg/dose every 48 hours

34-37 weeks 4 mg/kg/dose every 36 hours

≥38 weeks 4 mg/kg/dose every 24 hours

After the first week 4 mg/kg is administered as first dose. After 12-24 hours following the end of infusion the dose interval is calculated on the basis of serum concentration (Kanmaz, 2010).

*Side Effects:* 1/100- Rash, pruritus. Protein in the urine, an increase of uric acid in urine. Dizziness and balance disorders. The deterioration of hearing. 1/1000- Changes in blood picture. Urticaria. Changes in the liver. <1/1000- Headache. Anemia. Lowering blood pressure. Kidney damage (Young & Mangum, 2010).

*Administration and Storage Conditions:* Ampoules should be diluted before use. The drug diluted with SF can be stored for 3 days in refrigerator (Kanmaz, 2010).

*Incompatible Drugs:* Amphotericin B, Ampicillin, Furosemide, Heparin, Methicillin, Mezlocillin, Nafcillin, Oxacillin, Penicillin G, Propofol, Ticarcillin/Clavulanate (Kanmaz, 2010).
