FACE - Sinusitis - Acute, Mild to Moderate (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) >90% of acute sinusitis is viral in nature

 

 

Amoxicillin

(Amoxil®)

Pregnancy: B; Lactation: Unk

 

Children: 45-90 mg/kg/day (max 1500 mg/day) in divided doses three times daily for 10-14 days.

250 mg/5 mL at 90 mg/kg/day

 

8 kg (18 lb) = 1 tsp (5 mL) Q8H

17 kg (37 lb) = 2 tsp (10 mL) Q8H

>17 kg = Use adult dose.

 

Adult: 500 mg PO three times daily for 10-14 days.

 

Food: May take with or without meals.

 

Important side effects: Diarrhea and nausea. May cause nonallergic maculopapular rash.

 

Reduce dose if renal impairment (CrCl <30 mL/min).

Caps: 250 mg, 500 mg

Tabs: 500 mg, 875 mg

 

Chewable Tabs: 125, 250 mg

 

Susp:

125 mg/5 mL,

250 mg/5 mL,

400 mg/5 mL

 

Oral drops: 50 mg/mL

 

 

Amoxicillin/clavulanate

(Augmentin®)

Pregnancy: B;

Lactation: Consider Alt

 

Q12H Formulations:

Tabs:

500 mg/125 mg,

875 mg/125 mg,

1000 mg/ 62.5 XR

 

Oral Susp:

125 mg /31.25/ 5 mL

250 mg /62.5/ 5 mL

200 mg/28.5 mg/5 mL

400 mg/57 mg/5 mL

600 mg/42.5 mg/ 5 mL

 

Chew: 200, 400 mg

 

Augmentin 600 ES

Amoxicillin 600mg /42.9 mg

 

 

 

 

Neonates and infants <3 months:

Use 125 mg/31.25 mg/5 mL suspension.

 

30 mg/kg/day in divided doses every 12 hours

 

Children ≥3 months up to 40 kg: 40-45 mg amoxicillin component/kg/day (max 1600 mg/day) in divided doses two or three times daily for 10-14 days.

 

Q12H using 200 mg/5 mL susp

@ 45 mg/kg/day

 

9 kg (20 lb) = 1 tsp (5 mL) Q12H

13 kg (29 lb) = 1½ tsp (7.5 mL) Q12H

18 kg (40 lb) = 2 tsp (10 mL) Q12H

 

Q12H using 400 mg/5 mL susp

@ 45 mg/kg/day

18 kg (40 lb) = 1 tsp (5 mL) Q12H

27 kg (59 lb) = 1½ tsp (7.5 mL) Q12H

35 kg (77 lb) = 2 tsp (10 mL) Q12H

>40 kg = Use adult dosing (max 875 mg Q12H ).

 

Adult: 500-875 mg twice daily for 10-14 days.

 

Note: Q12H dosing may improve compliance compared to Q8H dosing.

 

 

 

Food: Take with food to reduce diarrhea.

 

Important side effects: Diarrhea (common), nausea, rash. May cause nonallergic maculopapular rash.

 

Use with caution in hepatic disease.

 

Reduce dose in renal impairment (CrCl <30 mL/min).

 

Cefpodoxime

(Vantin®)

Pregnancy: B; Lactation: Unsafe

 

Tabs: 100, 200 mg

 

Oral Susp:

50 mg/5 mL,

100 mg/5 mL

 

 

Children >5 months to 12 years:

 

10 mg/kg/day (max 400 mg) in divided doses twice daily for 10 days.

100 mg/5 mL @ 10 mg/kg/day

10 kg (22 lb) = 1 tsp (5 mL) Q24H

20 kg (44 lb) = 2 tsp (10 mL) Q24H

30 kg (66 lb) = 3 tsp Q24H

 

12 years to Adult: 200-400 mg twice daily for 10-14 days

 

 

 

Food: Take tablet with food. Suspension may be taken without regard to food.

 

Important side effects: Diarrhea.

 

Cefuroxime axetil

(Ceftin®)

Pregnancy: B; Lactation: Unsafe

 

Tabs: 125 mg, 250 mg, 500 mg

 

Oral Suspension:

125 mg/5 mL,

250 mg/5 mL

 

 

 

Children >3 months to 12 years:

30 mg/kg/day (max 1,000 mg/day) in divided doses twice daily for 10 days.

 

125 mg/5 mL @ 30 mg/kg/day

8 kg (18 lb) = 1 tsp (5 mL) Q12H

12.5 kg (27 lb) = 1½ tsp (7.5 mL) Q12H

17 kg (37 lb) = 2 tsp (10 mL) Q12H

25 kg (55 lb) = 3 tsp (15 mL) Q12H

33 kg (73 lb) = Use adult dose.

 

12 years to Adults: 250-500 mg PO twice daily for 7-14 days.

 

 

 

Food: Take suspension with food. Tablets may be taken without regard to food.

Important side effects: Nausea, vomiting, diarrhea.

 

Doxycycline

Vibramycin®

Generics available

Pregnancy: D; Lactation: Unsafe

 

Caps:

50 mg

100 mg

 

Tabs: 100 mg

 

Powder for Oral Suspension:

25 mg/5 mL

 

Syrup: 50 mg/5 mL

 

 

Children: 2-4 mg/kg/day (max 200 mg/day) in two divided doses.

 

Children ≥8 years and Adult: 50-100 mg twice daily.

 

Use in children <8 years old is generally not advised because tetracyclines can retard skeletal development and stain dental enamel. Doxycycline may have a role in some children <8 years old in certain tick-borne diseases. The dental risk is less than other tetracyclines and is related to duration of use.

 

 

Food: May take with food if GI upset occurs. Take 1 hour before or 2 hours after antacids, iron, milk, or other dairy products. Take with full glass of water to minimize esophagitis.

 

Important side effects: Photosensitivity, use sunscreen. Esophagitis, take with full glass of water. May discolor fingernails. Rash, nausea, diarrhea, superinfection, hepatitis.

 

Outdated tetracyclines are toxic and should not be used.

 

 

FACE - Sinusitis - Acute, Mild to Moderate with Beta-lactam Allergy (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis)

 

 

Azithromycin

(Zithromax®)

Pregnancy: B; Lactation: Unk

 

Tabs: 250 mg

Z-Pak

Tri-Pak

 

Oral Suspension:

100 mg/5 mL,

200 mg/5 mL

 

 

Children ≥6 months:

10 mg/kg/day (max 500 mg) daily × 1 day, then 5 mg/kg/day (max 250 mg) daily × 4 days.

 

100 mg/5 mL

10 kg (22 lb) = 1 tsp (5 mL)/day × 1 day, then ½ tsp (2.5 mL) daily for days 2-5.

 

200 mg/5 mL

20 kg (44 lb) = 1 tsp (5 mL)/day × 1 day, then ½ tsp (2.5 mL) daily for days 2-5.

30 kg (66 lb) = 1.5 tsp/day × 1 day, then ¾ tsp daily for days 2-5.

 

Adult: Dispense one Z-Pak.

 

 

Food: Suspension, 1 hour before or 2 hours after food. Tablets, without regard to food.

 

Important side effects: Nausea, diarrhea, elevated LFTs.

 

Clarithromycin

(Biaxin®, Biaxin XL®)

Pregnancy: C; Lactation: Unk

 

Tabs: 250 mg, 500 mg

Extended Release Tab (XL): 500 mg

 

Oral Susp:125 mg/5 mL,

250 mg/5 mL

 

Children ≥6 months: 15 mg/kg/day (max 1,000 mg/day) in divided doses twice daily for 10-14 days.

 

125 mg/5 mL @ 15 mg/kg/day

9 kg (20 lb) = ½ tsp (2.5 mL) Q12H

17 kg (37 lb) = 1 tsp (5 mL) Q12H

250 mg/5 mL @ 15 mg/kg/day

17 kg (37 lb) = ½ tsp (2.5 mL) Q12H

25 kg (55 lb) = ¾ tsp Q12H

33 kg (73 lb) = 1 tsp (5 mL) Q12H

 

Adult: 500 mg PO twice daily or 1 g XL PO once daily for 10-14 days.

 

 

Food: Extended release tablet with food. Others without regard to food.

Important side effects: Nausea.

 

 

Erythromycin estolate or base

(Ilosone®, E-mycin® , Ery-Tab®)

Generics available Pregnancy: B; Lactation: Unsafe

 

Estolate:

Tabs: 500 mg

 

Caps: 250 mg

 

Oral Susp:

125 mg/5 mL

250 mg/5 mL

 

Base:

Tabs: 250 mg, 333 mg, 500 mg

 

Caps: 250 mg, 500 mg PO

 

 

Children: 20-40 mg/kg/day estolate (max 2 g/day) in two to four divided doses daily for 10-14 days.

 

125 mg/5 mL @ 20 mg/kg/day

4-6 kg (10-15 lb) = ½ tsp (2.5 mL) Q12H

7-11 kg (16-25 lb) = 1 tsp (5 mL) Q12H

12-16 kg (26-35 lb) = 1½ tsp (7.5 mL) Q12H

 

250 mg/5 mL @ 20 mg/kg/day

17-25 kg (37-55 lb) = 1 tsp (5 mL) Q12H

26-37 kg (57-81 lb) = 1½ tsp (7.5 mL) Q12H

>38 kg (83 lb) = 500 mg Q12H

 

Adult: Erythromycin base or estolate 500 mg PO four times daily for 10-14 days.

 

Food: May take with or without meals. Take with food if causes GI upset.

 

Important side effects: GI upset, hepatitis.

 

Trimethoprim/Sulfamethoxazole

(Bactrim®, Septra®)

Generics available

Pregnancy: C; Lactation: Unsafe

 

Single Strength (SS) Tabs:

80 mg/400 mg

 

Double Strength (DS) Tabs:

160 mg/800 mg

 

Oral Susp: 40 mg/200 mg per 5 mL

 

 

Children >2 months:

8-10 mg/kg/day TMP component (max 320 mg/day) in divided doses twice daily for 10-14 days.

 

8-10 mg/kg/day @ 40 mg/200 mg/5 mL

10 kg (22 lb) = 1 tsp (5 mL) Q12H

20 kg (44 lb) = 2 tsp (10 mL) or 1 SS Tab Q12H

30 kg (66 lb) = 3 tsp (15 mL) or 1½ SS Tab Q12H

40 kg (88 lb) = 4 tsp (20 mL) or 2 SS Tabs

or 1 DS Tab Q12H

 

Adult: 1 DS Tab PO twice daily for 10-14 days.

 

Food: May take without regard to food. Encourage fluids.

 

Important side effects: Photosensitivity, rash.

 

Reduce dose if renal impairment (CrCl <30 mL/min).

 

FACE - Sinusitis - Acute - Failed Therapy or Antibiotic Use in the Past 4-6 Weeks (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis)

 

 

Levofloxacin

(Levaquin®)

Pregnancy: C; Lactation: Unsafe

 

Tabs: 250 mg, 500 mg

 

 

Adult: 500 mg PO once daily for

10-14 days.

 

 

Food: May take with or without meals. Do not take within 2 hours of antacids, magnesium, calcium supplements, zinc, aluminum, sucralfate, vitamins, or minerals (iron or zinc).

 

Important side effects: Photosensitivity, dizziness.

 

Reduce dose if renal impairment (CrCl <50 mL/min).