Drug | Daily pediatric dose | Usual maximum daily dose | Main and rare but serious adverse effects |
Amikacin*¶ |
|
| Auditory and vestibular toxic effects, nephrotoxic effects |
Amoxicillin-clavulanate |
|
| GI toxicity |
Bedaquiline |
| QT prolongation, neurologic toxicities such as paresthesia, tremor, anxiety, depression, insomnia, tinnitus and blurred vision | |
Capreomycin (not available in United States; limited availability elsewhere)*¶ |
|
| Ototoxicity, vestibular toxicity, nephrotoxicity, electrolyte disturbances, local pain with IM injections |
Clofazimine (not commercially available in the United States; requires application to FDA Division of Special Pathogen and Immunologic Drug Products; telephone 301-796-1600) |
|
| Red-grey discoloration of skin, eyes, body fluids, GI toxicity, photosensitivity, others |
Cycloserine◊ |
|
| Psychosis, personality changes, seizures, rash |
Delamanid |
|
| QT prolongation, neurologic toxicities such as paresthesia, tremor, anxiety, depression, insomnia, tinnitus, and blurred vision |
Ethionamide |
|
| GI tract disturbances, hepatotoxic effects, hypersensitivity reactions, hypothyroidism |
Imipenem-cilastatin |
|
| GI toxicity, seizures |
Isoniazid, high dose |
|
| Hepatitis, peripheral neuropathy (administer with pyridoxine), hypersensitivity, others |
Kanamycin*¶ |
|
| Auditory and vestibular toxic effects, nephrotoxic effects |
Levofloxacin¥ |
|
| Theoretical effect on growing cartilage, tendonitis, GI tract disturbances, cardiac disturbances, peripheral neuropathy, rash, headache, restlessness, confusion |
Linezolid |
|
| Myelosuppression |
Meropenem‡ |
|
| GI toxicity, seizures |
Moxifloxacin¥ |
|
| Theoretical effect on growing cartilage, tendonitis, GI tract disturbances, cardiac disturbances, peripheral neuropathy, rash, headache, restlessness, confusion |
Para-aminosalicylic acid |
|
| GI toxicity, hepatotoxicity, hypothyroidism (treat with thyroid replacement) |
Streptomycin*¶ |
|
| Auditory and vestibular toxic effects, nephrotoxic effects (which must be pre-emptively monitored) and rash |
Thiacetazone† (not available in United States) |
|
| Stevens-Johnson syndrome in HIV-infected patients, GI intolerance, hepatitis, skin reactions |
IM: intramuscular; IV: intravenous; GI: gastrointestinal.
* Generally given five to seven times per week (15 mg/kg or a maximum of 1 g per dose) for an initial two to four months and then (if needed) two to three times per week (20 to 30 mg/kg or a maximum of 1.5 g per dose). Dose should be decreased if renal function is diminished. Amikacin is preferred to kanamycin in children. Since IM injection of amikacin is very painful, IV infusion is preferred.
¶ For patients who are overweight or obese, dose is based on adjusted dosing weight (refer to the UpToDate calculator). When available, serum drug monitoring is advised to establish optimal dosing.
Δ Note dose of amikacin may need to exceed 20 mg/kg to reach a therapeutic level in young children.
◊ When available, serum drug monitoring is advised to establish optimal dosing. Recommended peak (two to four hours post-dose) level is not higher than 30 microg/mL.
§ Experience with imipenem-cilastatin in children with drug-resistant TB is very limited.
¥ According to the American Academy of Pediatrics, fluoroquinolones should not be used routinely as first-line agents in children <18 years old except when specific indications exist or in specific conditions for which there are no alternative agents and the drug is known to be effective for the specific situation.
‡ Dosing of meropenem in the setting of meningitis (in the absence of specific data for tuberculous meningitis) consists of 120 mg/kg in three divided doses.
† Should not be used in patients with HIV because of the serious risk of life-threatening adverse effects.Do you want to add Medilib to your home screen?