Streptococcus pneumoniae (Infants and Children)

Duration of Therapy

10-14 Days

If Penicillin MIC less than or equal to 0.06 mcg/mL

Penicillin G

66,500 units/kg IM/IV q4h

Dose limit: 24 million units/day (4 million units/dose)

If Penicillin MIC greater than or equal to 0.12 mg/mL AND Ceftriaxone MIC less than 1 mg/mL

Ceftriaxone

Greater than 1 month of age
100 mg/kg IV at 0, 12, and 24 h followed by 100 mg/kg IV q24h or 50 mg/kg IV q12h

Dose limit: 4 g/day (2 g/dose)

If Penicillin MIC greater than or equal to 0.12 mg/mL AND Ceftriaxone MIC greater than or equal to 1 mg/mL

Ceftriaxone

Greater than 1 month of age
100 mg/kg IV at 0, 12, and 24 h followed by 100 mg/kg IV q24h or 50 mg/kg IV q12h

Dose limit: 4 g/day (2 g/dose)

PLUS

Vancomycin

15mg/kg IV q6h

Max 1g/dose prior to Therapeutic Drug Monitoring

PCN Allergy

Meropenem

40mg/kg IV q8h

Dose limit: 6 g/day (2 g/dose)

Penicillin/Beta-lactam Allergy

If the patient has a true history of IgE mediated penicillin allergy, the risks versus benefit of empiric treatment of suspected meningitis with appropriate antimicrobials should be discussed.