**6.4.33 Meropenem**

*Uses:* Limited to treatment of pneumococcal meningitis and other serious infections caused by susceptible gram-negative organisms resistant to other antibiotics, especially extendedspectrum beta-lactamase producing *Klebsiella pneumonia* (Young & Mangum, 2010).

*Dose:* 20 mg/kg per dose IV

Less than 32 weeks GA, less than or equal to 14 days PNA: administered Q12 hours; after 14 days PNA: administered Q8 hours. 32 weeks and older GA, less than or equal to 7 days PNA: administered Q12 hours; after 7 days PNA: administered Q8 hours. Meningitis and infections caused by Pseudomonas species, all ages: 40mg/kg per dose Q8 hours. Give as an IV infusion over 30 minutes. Longer infusion times (up to 4 hours) may be associated with improved therapeutic efficacy (Young & Mangum, 2010).

*Adverse Effects:* Diarrhea (4%), nausea/vomiting (1%) and rash (2%). May cause inflammation at the injection site. The use of carbapenem antibiotics can result in the development of cephalosporin resistance in *Enterobacter, Pseudomonas, Serration, Proteus, Citrobacter,* and *Acinetobacte*r species. The risk of pseudomembranous colitis and fungal infections are also increased (Young & Mangum, 2010).

*Administration:* IV 30 min. infusion

*Preparation:* 500 mg meropenem is diluted with 10 ml proper solution. 50 mg/ml concentration is obtained.

Miscible Serums: 5% Dex, 10% Dex, SF

*Drugs to be confronted at the end point:* Dex/Amino acid, Lipid solution, Acyclovir, Aminophylline, Dopamine, Dobutamine, Fluconazole, Gentamicin, Heparin, Sodium bicarbonate, Vancomycin.

*Incompatibility:* Amphotericin B, Metronidazole, Acyclovir, Calcium gluconate, Diazepam, Zidovudine.

*Storage Conditions:* Diluted with sterile distilled water it can be stored for 2 hours under room temperature, 12 hours in refrigerator; diluted with SF for 2 hours under room

The Administration and Dose of Most Frequently Used Drugs in Pediatrics 331

*Dose:* 15 to 20 mg/kg IV infusion over at least 30 minutes, after that 4 to 8 mg/kg Q24 hours

*Adverse Effects:* Due to the central nervous system: Nystagmus, slurred speech, impaired motor coordination, may rarely occur: dizziness, insomnia, irritability, involuntary muscle

Due to the gastrointestinal tract: most - nausea, vomiting, constipation, in rare cases can lead

On the part of the skin: various forms of skin rashes, systemic lupus erythematous, Stevens -

On the part of the hematopoietic system: in rare cases there may be abnormal blood cell production - thrombocytopenia, leukopenia, granulocytopenia, and anemia Megaloblastic

*Preparation:* The maximum concentration should be 10 mg/ml when it is diluted with SF. 5

*Incompatible Drugs:* 5% Dex, 5% with Dextrose, Dex/Amino acid, Lipid emulsions, Aminophylline, Amicasin, Dobutamine, Fentanyl, Heparin, Potassium chloride, Vitamin K1. *Storage Conditions:* Unopened ampoules should be protected against light under room

*Uses:* Potassium deficiency. Prevention of excessive potassium smothering as a result of

*Dose:* 0.5 to 1 mEq/kg per day divided an administered with feedings. 1g KCl = 13.4 mEq

*Adverse Effects:* Confusion, anxiety, feeling like you might pass out; uneven heartbeat; extreme thirst, increased urination; leg discomfort; muscle weakness or limp feeling; numbness or tingly feeling in your hands or feet, or around your mouth; severe stomach pain, ongoing diarrhea or vomiting; black, bloody, or tarry stools; or coughing up blood or

*Preparation:* Maximum concentration via peripheral line is 40 mEq/L. and 80 mEq/L.

makrocytosis (equivalent of treatment with folic acid) (Young & Mangum, 2010).

*Administration Type:* Loading dose IV 30 minutes infusion, Maintenance dose IV slow.

spasms, headache, in very rare cases you may experience dyskinesia.

mg/ml concentration is obtained diluting 50 mg/ml with 9 ml SF. *Miscible Serums:* SF. Stability is ruined with most of the IV liquids.

temperature. Opened ampoules should not be delayed.

vomit that looks like coffee grounds (Young & Mangum, 2010).

through central vein. The desired amount is added to total solution.

*Miscible Serums:* Compatible with all standard IV solutions.

*Incompatibility:* Amphotericin B, Diazepam, Phenytoin.

taking diuretics, diabetes, long-term diarrhea.

**6.4.37 Potassium chloride** 

*Administration:* IV infusion

K+

*Drugs to be confronted at the end point:* Fluconazole, Sodium bicarbonate

IV or PO. Max 0.5 mg/kg/minute.

Johnson syndrome, toxic epidermolysis.

to hepatotoxicity.

temperature, 18 hours in refrigerator; diluted with 5% Dex for 1 hour under room temperature, 8 hours in refrigerator. These periods of time are valid for 50 mg/ml concentration (Kanmaz, 2010).

#### **6.4.34 Metronidazole**

*Uses:* Reserved for treatment of meningitis, ventriculitis, and endocarditis caused by Bacteroides fragilis and other anaerobes resistant to penicillin; treatment of serious intraabdominal infections; and treatment of infections caused by Trichomonas vaginalis. Treatment of C. difficile colitis.

*Dose:* Loading dose: 15 mg/kg PO or IV infusion by syringe pump over 60 minutes Maintenance dose: 7.5 mg/kg per dose PO or IV infusion over 60 minutes. Begin one dosing interval after initial dose. Adverse Effects: Seizures and sensory polyneuropathy have been reported in a few adult patients receiving high doses over a prolonged period. Drug metabolites may cause brownish discoloration of the urine (Young & Mangum, 2010).

#### **6.4.35 Phenobarbital**

It is a long-term effective MSS depressant. For sedation: infants and children; 2-3 mg/kg/day PO every 8-12 hours. For sleep: infants and children; 2-3 mg/kg/dose PO, if IM required it is repeated after 12-24 hours (Eroğlu, 2002).

*Dose:* 20 mg/kg IV, given slowly over 10 to 15 minutes. Refractory seizures: Additional 5 mg/kg doses, up to a total of 40 mg/kg.

Neonatal Abstinence Syndrome: 16 mg'kg PO on day 1.

*Uses:* Epilepsy, seizures primarily large, so called and grand mal seizures, which cover only part of the brain. Seizures in newborns.

*Adverse Effects:* Respiration and respiratory depression (Kanmaz, 2010). > 1 / 100 Drowsiness. Disturbances in attention. Irritability, especially in young children. The difficulty of concentration of vision. The difficulty in coordinating movements. Changes in the blood picture. Rash. Confusion, especially in older patients. 1/1000 The risk of mucous membrane of the mouth and teeth, especially during prolonged treatment. <1/1000 – Anemia (Young & Mangum, 2010).

 *Follow:* The therapeutic concentration is 15-30 mcg/ml. Respiratory depression is observed in concentration exceeding 60 mcg/ml. The serum half-life is longer in the first 1-2 weeks. The serum half-life differs in patients taking phenytoin and valproate (Kanmaz, 2010).

*Administration and Storage Conditions:* The ampoules should be used within 30 minutes after opening (Kanmaz, 2010).

*Incompatible Drugs:* Fat emulsions, Hydralazine, Hydrocortisone, Insulin, Clindamycin, Methadone, Midazolam, Morphine, Pancuronium, Ranitidine, Vancomycin (Kanmaz, 2010).

#### **6.4.36 Phenytoin**

*Uses:* Anticonvulsant often used to treat seizures refractory to phenobarbital.

*Dose:* 15 to 20 mg/kg IV infusion over at least 30 minutes, after that 4 to 8 mg/kg Q24 hours IV or PO. Max 0.5 mg/kg/minute.

*Adverse Effects:* Due to the central nervous system: Nystagmus, slurred speech, impaired motor coordination, may rarely occur: dizziness, insomnia, irritability, involuntary muscle spasms, headache, in very rare cases you may experience dyskinesia.

Due to the gastrointestinal tract: most - nausea, vomiting, constipation, in rare cases can lead to hepatotoxicity.

On the part of the skin: various forms of skin rashes, systemic lupus erythematous, Stevens - Johnson syndrome, toxic epidermolysis.

On the part of the hematopoietic system: in rare cases there may be abnormal blood cell production - thrombocytopenia, leukopenia, granulocytopenia, and anemia Megaloblastic makrocytosis (equivalent of treatment with folic acid) (Young & Mangum, 2010).

*Administration Type:* Loading dose IV 30 minutes infusion, Maintenance dose IV slow.

*Preparation:* The maximum concentration should be 10 mg/ml when it is diluted with SF. 5 mg/ml concentration is obtained diluting 50 mg/ml with 9 ml SF.

*Miscible Serums:* SF. Stability is ruined with most of the IV liquids.

*Drugs to be confronted at the end point:* Fluconazole, Sodium bicarbonate

*Incompatible Drugs:* 5% Dex, 5% with Dextrose, Dex/Amino acid, Lipid emulsions, Aminophylline, Amicasin, Dobutamine, Fentanyl, Heparin, Potassium chloride, Vitamin K1.

*Storage Conditions:* Unopened ampoules should be protected against light under room temperature. Opened ampoules should not be delayed.

#### **6.4.37 Potassium chloride**

330 Complementary Pediatrics

temperature, 18 hours in refrigerator; diluted with 5% Dex for 1 hour under room temperature, 8 hours in refrigerator. These periods of time are valid for 50 mg/ml

*Uses:* Reserved for treatment of meningitis, ventriculitis, and endocarditis caused by Bacteroides fragilis and other anaerobes resistant to penicillin; treatment of serious intraabdominal infections; and treatment of infections caused by Trichomonas vaginalis.

*Dose:* Loading dose: 15 mg/kg PO or IV infusion by syringe pump over 60 minutes Maintenance dose: 7.5 mg/kg per dose PO or IV infusion over 60 minutes. Begin one dosing interval after initial dose. Adverse Effects: Seizures and sensory polyneuropathy have been reported in a few adult patients receiving high doses over a prolonged period. Drug metabolites may cause brownish discoloration of the urine (Young & Mangum, 2010).

It is a long-term effective MSS depressant. For sedation: infants and children; 2-3 mg/kg/day PO every 8-12 hours. For sleep: infants and children; 2-3 mg/kg/dose PO, if IM

*Dose:* 20 mg/kg IV, given slowly over 10 to 15 minutes. Refractory seizures: Additional 5

*Uses:* Epilepsy, seizures primarily large, so called and grand mal seizures, which cover only

*Adverse Effects:* Respiration and respiratory depression (Kanmaz, 2010). > 1 / 100 Drowsiness. Disturbances in attention. Irritability, especially in young children. The difficulty of concentration of vision. The difficulty in coordinating movements. Changes in the blood picture. Rash. Confusion, especially in older patients. 1/1000 The risk of mucous membrane of the mouth and teeth, especially during prolonged treatment. <1/1000 –

 *Follow:* The therapeutic concentration is 15-30 mcg/ml. Respiratory depression is observed in concentration exceeding 60 mcg/ml. The serum half-life is longer in the first 1-2 weeks. The serum half-life differs in patients taking phenytoin and valproate (Kanmaz, 2010).

*Administration and Storage Conditions:* The ampoules should be used within 30 minutes after

*Incompatible Drugs:* Fat emulsions, Hydralazine, Hydrocortisone, Insulin, Clindamycin, Methadone, Midazolam, Morphine, Pancuronium, Ranitidine, Vancomycin (Kanmaz, 2010).

*Uses:* Anticonvulsant often used to treat seizures refractory to phenobarbital.

concentration (Kanmaz, 2010).

Treatment of C. difficile colitis.

**6.4.34 Metronidazole** 

**6.4.35 Phenobarbital** 

required it is repeated after 12-24 hours (Eroğlu, 2002).

Neonatal Abstinence Syndrome: 16 mg'kg PO on day 1.

mg/kg doses, up to a total of 40 mg/kg.

part of the brain. Seizures in newborns.

Anemia (Young & Mangum, 2010).

opening (Kanmaz, 2010).

**6.4.36 Phenytoin** 

*Uses:* Potassium deficiency. Prevention of excessive potassium smothering as a result of taking diuretics, diabetes, long-term diarrhea.

*Dose:* 0.5 to 1 mEq/kg per day divided an administered with feedings. 1g KCl = 13.4 mEq K+

*Adverse Effects:* Confusion, anxiety, feeling like you might pass out; uneven heartbeat; extreme thirst, increased urination; leg discomfort; muscle weakness or limp feeling; numbness or tingly feeling in your hands or feet, or around your mouth; severe stomach pain, ongoing diarrhea or vomiting; black, bloody, or tarry stools; or coughing up blood or vomit that looks like coffee grounds (Young & Mangum, 2010).

#### *Administration:* IV infusion

*Preparation:* Maximum concentration via peripheral line is 40 mEq/L. and 80 mEq/L. through central vein. The desired amount is added to total solution.

*Miscible Serums:* Compatible with all standard IV solutions.

*Incompatibility:* Amphotericin B, Diazepam, Phenytoin.

The Administration and Dose of Most Frequently Used Drugs in Pediatrics 333

hygienic care is provided at frequent intervals. Steroid can cause hyperkalemia when used with certain diuretics. Phenobarbiturates decrease the effect of steroids. Urinary and blood glucose investigations should be carried out especially in children with diabetics. It may be necessary to increase insulin dose. As it is a drug decreasing hypophyseal stimulation for a long-term it may cause adrenal insufficiency, in which cases such symptoms as loss of appetite, nausea, anorexia, pain, fever and painful urination may appear in children. The drug should be administered carefully in patients with previous psychological problems. The behaviors, emotional status, sleeping order and psychomotor activity changes of child should be monitored and notified to doctor especially on long-term treatments. The treatment should be ceased by gradually decreasing dose. Long-term applications should be avoided in that it has many side effects. Unless otherwise stated by manufacturer nurse

should protect drug against light and frost (Kavakl et al, 1998).

*Uses:* Prophylaxis of infants at high risk for RDS (those < 29 weeks gestation).

*Preparation:* It can be used by being added to parenteral nutrition solutions. *Miscible Serums:* 5% Dex, 10% Dex, SF, Ringer lactate, Amino acid solution.

Allergic shock. Irritation at the injection site (Young & Mangum, 2010).

*Storing Conditions:* Unopened ampoules are stored at room temperature under 25°C.

*Adverse Effects:* The preparation is generally well tolerated. <1/1000- Allergic reactions.

*Uses:* Prophylaxis and therapy on hemorrhagic disease of the newborn. Treatment of hypoprothrombinemia secondary to factors limiting absorption or synthesis of vitamin K. *Dose:* Preterm infants, 32 weeks gestation: BW > 1000 grams: 0.5 mg/kg IM. BW < 1000

*Mode of Action:* Preparation obtained from the lungs of beef. Lowers the surface tension of pulmonary alveoli, allowing easy opening of the alveoli and facilitates the process of

*Administration:* It is added to TPN solution in order to meet daily trace element need. IV infusion: Infusion should not be less than 6 and less than 24 hours. Contains Iron, Zinc,

**6.4.41 Surfactant** 

**6.4.42 Tracutil** 

respiration (Young & Mangum, 2010).

Manganese, Copper and Selenium.

*Incompatibility:* Sodium bicarbonate

**6.4.43 Vecuronium** 

*Dose:* 0.1. Mg/kg IV

**6.4.44 Vitamin K** 

*Dose:* 0.2 cc/kg in first week and then 0.5 cc/kg

*Uses:* Loosening the muscles before surgery.

grams: 0.3 mg/kg IM (Young & Mangum, 2010).
