Streptococcus pneumoniae (Neonates)

Duration of Therapy

10-14 Days

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

Penicillin G

0-7 Days of Age
80,000-150,000 units/kg IV/IM q8h

8-28 Days of Age
112,000 units/kg IV/IM q6h

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

Cefotaxime

Cefotaxime vs. Ceftriaxone

Cefotaxime used instead of Ceftriaxone due to:

Risk of bilirubin encephalopathy in neonates or preterm infants less than 1 month corrected age
Interaction with calcium-containing IV infusions, including TPN in neonates and preterm infants less than 1 month corrected age

0-7 days

Less than 2 kg:
50 mg/kg IV/IM q12h

Greater than 2 kg:
50 mg/kg IV/IM q8h-q12h

8-28 days

Less than 1.2 kg:
50 mg/kg IV/IM q12h

Between 1.2-2 kg:
50 mg/kg IV/IM q8h

Greater than 2 kg:
50 mg/kg IV/IM q6h-q8h

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

Cefotaxime

Cefotaxime vs. Ceftriaxone

Cefotaxime used instead of Ceftriaxone due to:

risk of bilirubin encephalopathy in neonates or preterm infants less than 1 month corrected age
interaction with calcium-containing IV infusions, including TPN in neonates and preterm infants less than 1 month corrected age

0-7 days

Less than 2 kg:
50 mg/kg IV/IM q12h

Greater than 2 kg:
50 mg/kg IV/IM q8h-q12h

8-28 days

Less than 1.2 kg:
50 mg/kg IV/IM q12h

Between 1.2-2 kg:
50 mg/kg IV/IM q8h

Greater than 2 kg:
50 mg/kg IV/IM q6h-q8h

PLUS

Vancomycin

Postmenstrual age less than 27 wks
24 mg/kg IV q24h

Postmenstrual age 27-36 wks
18 mg/kg IV q8h

Postmenstrual age greater than or equal to 37wks
15 mg/kg IV q6h

PCN Allergy

Meropenem

40mg/kg IV q8h

Penicillin/Beta-lactam Allergy

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