*6.1.4.1.1 Cephadroxil*

306 Complementary Pediatrics

*Dose:* Dose is determined by your doctor. Typically, adults and children weighing over 30 kg - 375-750 mg 2 times daily for 5-14 days. Children under 30 kg body weight, have completed one year of age - 25 - 50 mg /kg body weight per day in two divided doses every 12 hours. *Uses:* Broad-spectrum antibiotic useful against group *B. streptococcus, Listeria monocytogenes*,

*Adverse Effectes:* Very large doses may results in CNS excitation or seizure activity. Moderate prolongation of bleeding times (by approximately 60 second) may occure after repeated doses. Hypersensitivity reaction (maculopapular rash, ulticarial rash, off fever) are rare in

Penicillin allergy can be diagnosed by taking a skin test. Acute allergic reactions can be such delayed reactions as anaphylaxis, angioneurotic edema and urticarial; and also be fever, eosinophilia, hemolytic anemia, serum disease, urticarial and maculopapular rash. The

High doses can cause CNS toxicity, hypopotassemia and coagulation impairments (Apak,

Their mechanisms of action resemble to penicillin. They are grouped in four generations. As the generation increases the activity against gram (-) also increases. The ones aside from cefuroxime and third-generation are not able to penetrate CNS. They cannot be used in bacterial meningitis treatment. Cephalosporins are commonly used because of their clinical

While maculopapular rash, drug-related fever and positive Coomb's test are the major side effects such reactions and anaphylaxis as urticarial and serum diseases are rarely seen (Rang

Cephalosporins cause allergic reactions in patients allergic to Penicillin. With the use of cephalosporin side effects are observed in 10% of the patients allergic to Penicillin (Puchner

They are active against gram (+) cocci including staphylococcus aureus, and such gram (-) organisms as *E. coli* and *Klebsiella*. They are inactive against enterococci and H. influenzae. First-class cephalosporins cannot cross the blood-brain barrier and so are not effective in the treatment of central nervous system infections (Apak, 1996; Behrman & Kliegman, 2001;

utilities in the treatment of common infections (Rang et al, 1998; Zeph, 2002).

presence of rash is not indication to cease drug use (Eroğlu, 2002).

*6.1.2.2.3 Ampicillin sodium sulbactam* 

neonates (Young & Mangum, 2010).

**6.1.3 Side effects of penicillin** 

**6.1.3.1 Allergic reactions** 

**6.1.3.2 Dose-related effects** 

1996; Eroğlu, 2002).

**6.1.4 Cephalosporins** 

et al, 1998; Zeph, 2002).

& Zacharisen, 2002).

**6.1.4.1 First-generation cephalosporins** 

Dökmeci, 2000; Eroğlu, 2002).

and suscetible *E coli* species

Administered at the dose of 30 mg/kg/day (every 12 hours) PO, It has such side effects as hypersensitivity reactions, rarely renal toxicity, neuropathy, and eosinophilia (Apak, 1996; Behrman & Kliegman, 2001; Eroğlu, 2002).

#### *6.1.4.1.2 Cephalothin*

Newborn; IV (15-30 min.), IM <7 days; 40 mg/kg/day administered every 12 hours; >7 days; 60 mg/kg/day administered every 8 hours. The side effects are the same as in cephadroxil (Apak, 1996; Eroğlu, 2002).

#### *6.1.4.1.3 Cefazolin sodium*

Newborn; 40 mg/kg/day IM-IV administered every 6 hours. Cefazol, Cefamezin, Maksiporin, Cefozin are its derivatives. It rarely has such side effect as rash, positive Coomb's test, coagulopathy in uremic patients (Apak, 1996; Eroğlu, 2002).

#### **6.1.4.2 Second-generation cephalosporins**

They are used in gram (+) cocci, penicillinase producing and not producing H. influenzae, in *Klebsiella pneumonia* related bronchopulmonary infections, in E. Coli or proteus related nosocomial infections, in urinary infections caused by enterobacters and in the treatment of sinusitis and otitis media for the ones allergic to amoxicillin (Dökmeci, 2001).

Unlike others Cefuroxime is the only second-generation cephalosporin to cross blood-brain barrier. In case of an infection it is able to penetrate CNS. It is especially used in H. influenzae meningitis and sepsis treatment (Eroğlu, 2002).

#### *6.1.4.2.1 Cefaclor*

It is used in the treatment of upper and lower respiratory tract, urinary tract, skin and soft tissue infections as well as in otitis media and susceptible organisms. And it is administered every 8 hours at a dose of 20-40 mg/kg/day (Behrman & Kliegman, 2001; Eroğlu, 2002).

#### *6.1.4.2.2 Cefoxitin*

In children older than 3 months it is administered every 6-8 hours at a dose of 60-80 mg/kg/day either as IV or IM. It can cause thrombophlebitis, diarrhea and pseudomembranous colitis (Apak, 1996; Eroğlu, 2002).

#### **6.1.4.3 Third-generation cephalosporins**

Compared to first-generation cephalosporins they are less active against gram (+) cocci; however more active against most of the strains of gram (-) cocci. While they are moderately active against *Pseudomonas aeruginosa* they are more active against *H. influenza* and *N. gonorrhoeae*. They can easily penetrate into CNS from inflamed meninges. They are usually discharged from kidneys (Dökmeci, 2000).

#### *6.1.4.3.1 Cefotaxime sodium*

Treatment of neonatal meningitis and sepsis caused by susceptible gram-negative organisms (e.g. *E coli, H influenzae,* and *Klebsiella*), Treatment of disseminated gonococcal infections.

*Dose:* 50 mg/kg IV (Young & Mangum, 2010).

The Administration and Dose of Most Frequently Used Drugs in Pediatrics 309

*Side Effects:* Nephrotoxicity, ototoxicity, arthralgia, rash, eosinophil, neuromuscular block

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

<1/1000- Headache. Lowering blood pressure. Reducing the number of white blood cells,

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

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

30-36 weeks →0-14 mg/kg/dose every 48 hours

37-44 weeks→ 0-7 mg/kg/dose every 48 hours

≥45 weeks every 24 hours for all (Kanmaz, 2010).

>14 mg/kg/dose every 24 hours

>7 mg/kg/dose every 24 hours

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

Other adverse reactions which have occurred rarely are allergic reactions, thrombocytopenic

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,

Gestation age ≤29 weeks→ 0-14 mg/kg/dose every 72 hours

platelet count. Anemia. Tingling. Convulsions. Arthralgia (Young & Mangum, 2010). *Incompatibility:* Lipid solution, Ampicillin, amphotericin B, phenytoin (Kanmaz, 2010).

≥ 34→ 15 mg/kg/dose every 24 hours (Kanmaz, 2010).

31-33 → 16 mg/kg/dose every 36 hours

Newborn ; Gestation age ≤ 27 → 18 mg/kg/dose every 48 hours 28-30 → 18 mg/kg/dose every 36 hours

may develop (Apak, 1996).

picture.

al, 1998).

**6.1.5.2 Gentamicin** 

(Kanmaz, 2010).

2010).

and conjunctival hyperemia.

purpura, and hallucinations (Young & Mangum, 2010).

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

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

*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 (Young & Mangum, 2010).
