Version October 2024
| Class | Antibiotic | Adult dosing | Pediatric dosing |
| Preferred agents | |||
| Fluoroquinolone | Ciprofloxacin* | 400 mg IV every 8 hours | 20 to 30 mg/kg per day IV divided every 8 to 12 hours (maximum daily dose: 800 to 1200 mg/day) |
| Anti-pseudomonal beta-lactams | Cefepime | 2 g IV every 8 to 12 hours | 50 mg/kg/dose IV every 8 hours (maximum dose: 2 g per dose) |
| Ceftazidime | 2 g IV every 8 hours | 100 to 150 mg/kg per day IV divided every 8 hours (maximum daily dose: 6 g per day)¶ | |
| Piperacillin-tazobactamΔ | 4.5 g IV every 6 hours | Infants >6 months, children, and adolescents: 240 to 300 mg piperacillin/kg per day IV divided every 6 hours (maximum daily dose: 16 g/day) | |
| Alternative agents | |||
| Monobactam | Aztreonam◊ | 2 g IV every 8 hours | 90 to 120 mg/kg/day IV divided every 6 to 8 hours (maximum daily dose: 8 g/day) |
| Carbapenem | Meropenem | 1 g IV every 8 hours If intracranial extension is a concern, increase dose to 2 g IV every 8 hours | 60 mg/kg per day IV every 8 hours (maximum daily dose: 3 g per day) If intracranial extension is a concern, increase dose to 120 mg/kg per day IV divided every 8 hours (maximum daily dose: 6 g per day) |
This table summarizes IV antibiotic dosing for adults and children for the treatment of necrotizing (malignant) external otitis.
All dosing is for patients with normal kidney function; refer to drug monographs for dose adjustments for kidney impairment. Pediatric dosing is for patients >28 days, unless otherwise noted. For discussion of agent selection and duration of therapy, refer to the UpToDate topic on necrotizing (malignant) external otitis.IV: intravenous.
* Ciprofloxacin may be given orally in patients with adequate gastrointestinal absorption. For select immunocompetent patients, oral ciprofloxacin may be given as monotherapy; for all other patients, it is administered in combination with an IV anti-pseudomonal beta-lactam. Refer to the UpToDate topic on necrotizing external otitis for details. For adults, the oral ciprofloxacin dose is 750 mg orally every 12 hours; for children, the dose is 20 to 30 mg/kg per day orally divided every 12 hours (maximum: 1500 mg/day).
¶ For severe Pseudomonas spp infections, use the following pediatric ceftazidime dosing: 200 to 300 mg/kg/day divided every 8 hours (maximum daily dose: 12 g/day).
Δ Adult piperacillin-tazobactam dosing is expressed as the combined amount of piperacillin and tazobactam. Pediatric piperacillin-tazobactam dosing is expressed as mg of piperacillin. Piperacillin-tazobactam is supplied as a combination product that contains piperacillin and tazobactam in an 8:1 ratio (eg, for every 1 g of piperacillin, there is 0.125 g of tazobactam, which is equivalent to 1.125 g of total piperacillin and tazobactam).
◊ Aztreonam is used as a second anti-pseudomonal agent in patients requiring empiric combination therapy who cannot tolerate ciprofloxacin or a beta-lactam.Do you want to add Medilib to your home screen?
