Bacterial meningitis
Adult: In combination with another antibiotic if needed: 1,000-2,000 mg 4-6 hourly via slow IV inj over 3-4 minutes or IV infusion over 20-60 minutes. Doses may also be given via IM inj if IV route is impossible or less appropriate for the patient. Max: 12,000 mg daily (IV); 4,000 mg daily (IM); 1,000 mg (single IM dose). Consideration must be given to local treatment guidelines.
Intramuscular, Intravenous
Endocarditis
Adult: Treatment: 1,000-2,000 mg 4-6 hourly via slow IV inj over 3-4 minutes or IV infusion over 20-60 minutes. Doses may also be given via IM inj if IV route is impossible or less appropriate for the patient. Max: 12,000 mg daily (IV); 4,000 mg daily (IM); 1,000 mg (single IM dose). Prophylaxis in patients at highest risk of infective endocarditis: 2,000 mg as a single IV dose 30-60 minutes prior to the procedure. Consideration must be given to local treatment guidelines.
Child: Treatment: ≥40 kg: Same as adult dose. Prophylaxis in patients at highest risk of infective endocarditis: >3 months <40 kg: 50 mg/kg as a single IV dose 30-60 minutes prior to the procedure; ≥40 kg: Same as adult dose.
Child: Treatment: ≥40 kg: Same as adult dose. Prophylaxis in patients at highest risk of infective endocarditis: >3 months <40 kg: 50 mg/kg as a single IV dose 30-60 minutes prior to the procedure; ≥40 kg: Same as adult dose.
Intramuscular, Intravenous
Acute cystitis, Acute exacerbations of chronic bronchitis, Acute pyelonephritis, Community-acquired pneumonia, Dental abscess with spreading cellulitis, Ear, nose and/or throat infections, Prosthetic joint infection
Adult: 750-2,000 mg 8 hourly or 2,000 mg 12 hourly via slow IV inj over 3-4 minutes or IV infusion over 20-60 minutes. Doses may also be given via IM inj if IV route is impossible or less appropriate for the patient. Max: 12,000 mg daily (IV); 4,000 mg daily (IM); 1,000 mg (single IM dose). Consideration must be given to local treatment guidelines.
Child: 1-3 months 20-150 mg/kg daily given in 3 equally divided doses of up to 25 mg/kg or infusion of up to 50 mg/kg; >3 months <40 kg: 20-200 mg/kg daily given in 2-4 equally divided doses of up to 25 mg/kg or infusions of up to 50 mg/kg. Max: 120 mg/kg daily in 2-6 equally divided doses (IM); ≥40 kg: Same as adult dose.
Child: 1-3 months 20-150 mg/kg daily given in 3 equally divided doses of up to 25 mg/kg or infusion of up to 50 mg/kg; >3 months <40 kg: 20-200 mg/kg daily given in 2-4 equally divided doses of up to 25 mg/kg or infusions of up to 50 mg/kg. Max: 120 mg/kg daily in 2-6 equally divided doses (IM); ≥40 kg: Same as adult dose.
Intravenous
Lyme disease
Adult: In late stage (systemic involvement): 2,000 mg 8 hourly via slow IV inj over 3-4 minutes or IV infusion over 20-60 minutes. Consideration must be given to local treatment guidelines.
Child: >3 months <40 kg: In early stages: 25-50 mg/kg daily given in 3 divided doses for 10 days (range: 10-21 days). In late stages (systemic involvement): 50 mg/kg daily given in 3 divided doses; ≥40 kg: Same as adult dose.
Child: >3 months <40 kg: In early stages: 25-50 mg/kg daily given in 3 divided doses for 10 days (range: 10-21 days). In late stages (systemic involvement): 50 mg/kg daily given in 3 divided doses; ≥40 kg: Same as adult dose.
Oral
Acute streptococcal pharyngitis, Acute streptococcal tonsillitis
Adult: 500 mg 8 hourly or 750-1,000 mg 12 hourly. For severe infections: 750-1,000 mg 8 hourly for 10 days. Consideration must be given to local treatment guidelines.
Child: <40 kg: 40-90 mg/kg daily in divided doses; ≥40 kg: Same as adult dose.
Child: <40 kg: 40-90 mg/kg daily in divided doses; ≥40 kg: Same as adult dose.
Oral
Community-acquired pneumonia
Adult: 500-1,000 mg 8 hourly. Consideration must be given to local treatment guidelines.
Child: <40 kg: 20-90 mg/kg daily in divided doses; ≥40 kg: Same as adult dose.
Child: <40 kg: 20-90 mg/kg daily in divided doses; ≥40 kg: Same as adult dose.
Oral
Prophylaxis of endocarditis
Adult: 2,000 mg as a single dose 30-60 minutes prior to the procedure. Consideration must be given to local treatment guidelines.
Child: <40 kg: 50 mg/kg as a single dose 30-60 minutes prior to the procedure; ≥40 kg: Same as adult dose.
Child: <40 kg: 50 mg/kg as a single dose 30-60 minutes prior to the procedure; ≥40 kg: Same as adult dose.
Oral
Acute bacterial sinusitis, Acute cystitis, Acute otitis media, Acute pyelonephritis, Dental abscess with spreading cellulitis, Ear, nose and/or throat infections, Genitourinary infections, Skin and soft tissue infections
Adult: 250-500 mg 8 hourly or 750-1,000 mg 12 hourly. For severe infections: 750-1,000 mg 8 hourly. Consideration must be given to local treatment guidelines.
Child: <40 kg: 20-90 mg/kg daily in divided doses; ≥40 kg: Same as adult dose.
Child: <40 kg: 20-90 mg/kg daily in divided doses; ≥40 kg: Same as adult dose.
Oral
Susceptible infections
Neonate: Preterm and term neonates 15 mg/kg 12 hourly. Alternatively, for preterm and term neonates weighing 1.5-<2 kg: 37.5 mg/kg 12 hourly; ≥2 kg: 50 mg/kg 12 hourly. Dosage recommendations may vary among local guidelines (refer to specific country guidelines).
Oral
Prophylaxis of urinary tract infections
Neonate: For patients with hydronephrosis or vesicoureteral reflux: 10-15 mg/kg once daily. Recommendations may be off-label in some countries (refer to the latest local guidelines).
Oral
Acute exacerbations of chronic bronchitis, Asymptomatic bacteriuria in pregnancy
Adult: 250-500 mg 8 hourly or 750-1,000 mg 12 hourly. For severe infections: 750-1,000 mg 8 hourly. Consideration must be given to local treatment guidelines.
Oral
Lyme disease
Adult: In early stages: 500-1,000 mg 8 hourly for 14 days (range: 10-21 days). Max: 4,000 mg daily in divided doses. In late stages (systemic involvement): 500-2,000 mg 8 hourly for 10-30 days. Max: 6,000 mg daily in divided doses. Consideration must be given to local treatment guidelines.
Child: <40 kg: In early stages: 25-50 mg/kg daily in 3 divided doses for 10-21 days. In late stages (systemic involvement): 100 mg/kg daily in 3 divided doses for 10-30 days. ≥40 kg: Same as adult dose.
Child: <40 kg: In early stages: 25-50 mg/kg daily in 3 divided doses for 10-21 days. In late stages (systemic involvement): 100 mg/kg daily in 3 divided doses for 10-30 days. ≥40 kg: Same as adult dose.
Oral
Eradication of Helicobacter pylori associated with peptic ulcer disease
Adult: In combination with PPI (e.g. omeprazole, lansoprazole) and another antibiotic (e.g. clarithromycin, metronidazole): 750-1,000 mg bid for 7-14 days depending on therapy regimen. Consideration must be given to local treatment guidelines.
Oral
Paratyphoid fever, Typhoid fever
Adult: 500-2,000 mg 8 hourly. Consideration must be given to local treatment guidelines.
Child: <40 kg: 100 mg/kg daily in 3 divided doses; ≥40 kg: Same as adult dose.
Child: <40 kg: 100 mg/kg daily in 3 divided doses; ≥40 kg: Same as adult dose.
Oral
Uncomplicated gonorrhoea
Adult: In patients with susceptible non-penicillinase-producing Neisseria gonorrhoeae strains: 3 g as a single dose in combination with probenecid. Consideration must be given to local treatment guidelines.