General Medical Officer (GMO) Manual: Clinical Section: Pediatric Formulary

Antibiotics

Name	Dosage	Common Preparations	Comments	Indications
Amoxicillin	40mg/kg/day divided TID, may give with food	Susp250/5cc Chew 125mg Tabs 250mg	Side effects: papular rash, diarrhea, candidiasis	1st line for otitis media and sinusitis
Augmentin (Amoxicillin/Clavulanate)	45 mg/kg/day divided TID, may give with food	Susp250/5cc Chew125mg Tabs 250mg	Side effects: diarrhea (more than amoxicillin), papular rash, candidiasis	2nd line for otitis media pneumonia sinusitis
Pediazole (Erythromycin/Sulfisoxazole)	50 mg/kg/day divided TID, may give with or without food	Susp: E-mycin 200mg / Sulf 600mg / 5cc	Not recommended under 2 months of age. Do not give in those with G6PD deficiency	2nd line for otitis media pneumonia sinusitis
Erythromycin	40 mg/kg/day divided TID or QID, give after food	Susp 200mg/5cc Tabs 250mg	Side effects: GI upset (32 %), rash. Interacts with tegretol, hismanol, seldane, theophylline	Respiratory, skin, and soft tissue infections
Septra, Bactrim (Trimethoprim /Sulfamethoxazole)	8 mg/kg/day divided BID (based upon Trimeth)	Susp. 40mg TMP/ 5cc Tabs 80mg TMP or 160mg TMP	Not recommended under 2 months of age Not in G6PD deficiency Side effects: rash	1st line for UTI 2nd line otitis media
Suprax (Cefixime)	8 mg/kg/day QD	Susp100mg/5cc Tab200mg, 400mg	Not recommended under 6 months of age Side effects: diarrhea	2nd line otitis media Sinusitis Pneumonia
Dicloxacillin	40 mg/kg/day divided QID	Susp 62.5/5cc Caps 125mg, 250mg, 500mg	Foul-tasting suspension Side effects: rash Give 1 hour before or 2 hours after meals	1st line Impetigo, Cellultis
Keflex (Cephalexin)	50 mg/kg/day divided Q6 – Q 12 hours, Give on an empty stomach	Susp125mg/5cc Caps250mg, 500 mg	Good tasting suspension Side effects: rash, nausea	Skin, respiratory, and GU infections
Zithromax (Azithromycin)	Pneumonia: 10 mg/kg (max 500mg/day) for first day, then 5 mg/kg (max 250mg/day) for days 2 through 5, Pharyngitis: 12 mg/kg (max 500mg/day) once daily for 5 days.	Susp 100mg/5cc, 200mg/5cc	Not recommended under 6 months (pneumonia) or under 2 years (pharyngitis). Take 1 hour before or 2 hours after meals. Side effects: GI upset	Community-acquired pneumonia, pharyngitis

Parenteral

Name	Dosage	Comments	Indications
Bicillin C-R 900/300 (Pen G)	25,000–50,000 units/kg of benzathine deep IM only, max 1.2 million units. Do not give IV.	Side effects: rash, superinfection	Single dose for Group A Streptococcal infections
Claforan (Cefotaxime)	100-200 mg/kg/24h divided q6h-q8h, IV, IM max 12 g/day	Side effects: local or hypersensitivity reactions, diarrhea, rash.	Meningitis Sepsis
Rocephin (Ceftriaxone)	50-100 mg/kg/24h IV, IM 100mg/kg/24h divided q12h for meningitis max 4 g/day	Displaces bilirubin from albumin Side effects: diarrhea, rash, superinfection, sludging in gall bladder	Meningitis Sepsis
Zinacef (Cefuroxime)	75-150 mg/kg/24h divided q8h, IV, IM max 6g/day	Side effects: GI upset, rash	Pneumonia, sinusitis, not recommended for meningitis

Antipyretics

Name	Dose	Common Preparations	Indications
Tylenol (Acetaminophen )	10-15 mg/kg per dose q4h PO/PR prn	Drops 80mg / 0.8cc Elixir160mg / 5cc Chew 80mg Caplet 160mg Tabs325mg and 500mg	Fever, pain
Motrin (Ibuprofen)	10 mg/kg per dose QID max 40mg/kg/day. Not recommended under 6 months May give with food	Susp100mg/5mL Tabs 200, 400, 600, 800mg	Fever, pain

Antihistamines

Name	Dose	Common Preparations	Comments	Indications
Benadryl (Diphenhydramine)	5 mg/kg/day divided QID	Elixir 12.5mg/5cc Caps 25/50mg Tabs 50mg	Side effects: drowsiness.	Urticaria Pruritis Eczema
Atarax (Hydroxyzine)	2 mg/kg/day divided TID, QID	Syrup 10mg/5cc Tabs 10 / 25 /100mg	Side effects: dry mouth, drowsiness	Same as Benadryl

Decongestants

Name

Dosage

Comments

Indications

Dimetapp

(Brompheniramine and phenylpropanolamine)

1-6 months: 1.25 ml TID, QID

7-24 months: 2.5 ml TID, QID

2 to 4 years: 3.74 ml TID, QID

4 to 12 years: 5 ml TID, QID

>12 years: 5-10 ml TID, QID,

or 1 tab BID

DM preparations antitussive
Side effects: drowsiness to excitability, nausea

Rhinorrhea, nasal congestion

Sudafed

(Pseudoephedrine HCl)

< 2 years: 4 mg/kg/day divided QID
2-5 years: 15 mg QID
6-12 years: 30 mg QID
>12 years: 60 mg QID
Give with liquids,
max dose 240 mg/ 24 hours

Decongestant, sympathomimetic

Side effects: tachycardia, nausea, excitability

Nasal congestion

Respiratory Distress

Asthma

Name	Common Preparations	Dosage	Comments
Albuterol (Ventolin, Proventil)	Syrup: 2 mg/5cc Nebulizer solution: 5 mg/cc Metered Dose Inhaler (MDI): 90 mcg/puff	Syrup: 0.1mg/kg divided TID Nebulized solution: 2.5-5 mg/3cc of normal saline every 20 minutes x 3 doses then reassess, do peak flow MDI with spacer: 2 puffs QID and prior to exercise as needed; 4 to 8 puffs every 20 minutes if in acute bronchospasm	Drug of choice for acute bronchospasm Under 2 years not recommended Side effects: tachycardia, agitation, tremor Excessive or prolonged use can lead to tolerance
Epinephrine	1 mg/ ml = (1:1000) 5 mg/ml = (1:200)	0.01mg/kg up to 0.5 mg every 20 minutes x 3 subcutaneous in ER setting	Side effects: tachycardia, anxiety, hypertension, tremor
Corticosteroids (prednisone, prednisolone - Pediapred, methylprednisolone)	Prednisone - Oral: 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg, Prednisolone – Oral solution: 5 mg/5 cc Methyprednisolone – Oral: 2mg, 4mg, 8 mg, 16 mg, 32 mg Other preparations include IV, IM, MDI	Oral: short course "burst": 1-2 mg/kg/day PO (max 60 mg/day) for 3 to 10 days IV: 1 mg/kg IV every 6 hours for 48 hour hospitalization	With chronic use: Cushing’s Syndrome, peptic ulcer disease, acne
Intal (Cromolyn Sodium)	Nebulizer solution: 20 mg/2 cc ampule MDI: 0.8 mg/puff	Nebulized solution: 20 mg QID, under 2 years of age not recommended; MDI: 2 puffs QID, not recommended under 5 years of age	Mast cell stabilizer without any bronchodilating effect, only used only for prophylaxis

Croup

Name	Dosage	Comments
Racemic Epinephrine (Vaponefrin)	0.25-0.75 ml of 2.25% racemic epinephrine solution in 2.5 ml saline via nebulizer every 2 hours as needed	Rebound stridor very common Observe 12-24 hrs after use Side effects: tachycardia, anxiety, hypertension
See Corticosteroids above

Anticonvulsant treatment for ongoing seizure activity

Name	Preparations	Dosage	Comments
Lorazepam (Ativan)	2 mg/ml 4 mg/ml	0.05-0.10 mg/kg IV over 2-5 minutes IV every 10 to 15 minutes, max dose = 4mg/kg. Same dose may be given PR or sublingually if no IV access.	Benzodiazepine, anticonvulsant, sedative, anti-anxiety, hypnotic. Side effects: respiratory depression, confusion.
Diazepam (Valium)	5 mg/ml	0.2-0.3 mg/kg/dose IV every 2-5 minutes. PR: 0.5 mg/kg/dose max dose = 1-2 mg/minute IV push.	Benzodiazepine, anticonvulsant, sedative, anti-anxiety, hypnotic. Interacts with other CNS depressants, tagamet, erythromycin, valproic acid Side effects: respiratory depression, drowsiness, and confusion.
Versed (Midazolam)	1 mg/ml 5 mg/ml	0.2 mg/kg IM 0.15 mg/kg IV Although IV versed has no advantage over valium or ativan, it is efficacious as an IM anticonvulsant when IV or IO access is not available. Currently, versed is the only anticonvulsant with a rapid onset of action that can be safely given as either IV or IM.	Benzodiazepine, anticonvulsant, sedative, hypnotic. Interacts with other CNS depressants, tagamet, erythromycin, rifampin, theophylline. Side effects: respiratory depression, sedation, amnesia, nausea.
Phenobarbital	30 mg/ml 60 mg/ml 65 mg/ml 130 mg/ml	10-15 mg/kg IV loading dose; then 3-5 mg/kg/day IV or PO maintenance dose divided QD or BID (this may vary widely dependent upon age) Do not exceed 1 mg/kg/minute IV.	Barbiturate, anticonvulsant, sedative, hypnotic. Interacts with valproic acid, oral contraceptives, griseofulvin, theophylline, corticosteroids, and doxycycline. Side effects: respiratory depression, apnea, hypotension, and drowsiness.
Dilantin (Phenytoin)	50 mg/ml	15-20 mg/kg IV loading dose; 5-10 mg/kg/day IV or PO, maintenance dose divided BID, TID. Do not exceed 1-3 mg/kg/min IV, max 50mg/min IV. IV flushes should be followed by normal saline flushes. Need telemetry monitoring	Anticonvulsant, antiarrythmic Interacts with valproic acid, oral contraceptives, rifampin, theophylline, corticosteroids, sulfonamides, and doxycycline. Side effects: rhythm disturbances, hypotension, nausea, slurred speech, ataxia

Revised by CDR Wendy Bailey, MC, USN, Pediatrics Specialty Leader, Naval Medical Center San Diego, San Diego, CA (1999). Reviewed by CAPT Robert Wilkins, MSC, USN, Pharmacology Specialty Leader, Bureau of Medicine and Surgery, Washington, D.C. (1999).

Preface · Administrative Section · Clinical Section

The General Medical Officer Manual , NAVMEDPUB 5134, January 1, 2000
Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300

This web version of The General Medical Officer Manual, NAVMEDPUB 5134 is provided by The Brookside Associates Medical Education Division. It contains original contents from the official US Navy version, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense. All material in this version is unclassified. This formatting © 2006 Medical Education Division, Brookside Associates, Ltd. All rights reserved.

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