 Reversal of severe sinus bradycardia, particularly when  parasympathetic influences on heart (digoxin, beta-blockers,  hyperactive carotid sinus reflex) predominate.  iThe muscarinic effects of neostigmine when reversing  neuromuscular blockade.    Cardiac arrhythmias particularly during the first 2 minutes  following IV use.    Dose: 75-175 pg via jet nebulizer Q6-8h  Dose: 25 pg/kg/dose via nebulizer Q8h G ° mella2009    Anti-cholinergic bronchodilator for primary treatment of COPD  and adjunctive treatment of acute bronchospasm (peak effect  within l-2h ; duration of effect 4-6h).    Bronchodilator effect may be potentiated when given  wirh R-2 agonist i.e. albuterol. Both drugs are  compatible when admixed if given within 1 h.   Precipitation of narrow-angle glaucoma or eye pain (if solution  comes into direct contact with the eyes).    PT and Neonates < 7 days: 30 mg/kg IV Q12h  Neonate 7-28 days: 30 mg/kg IV Q8h BNFC2 “ 9    Broad-Spectrum antibiotic against H. influenzae, N. gonorrhea, E.  coli, Pneumococci, Streptococci, and certain strains of  Staphylococci.    Cr Cl 10-30 mL/min/1.73m 2 <=> use normal initial IV dose then half dose Q12h  Cr Cl <10 mL/min/1.73m 2 ^ use normal initial IV dose then half dose Q24h    GFR 10-30 mL/min/1.73m 2c > use normal dose Q12h  GFR<10 mL/min/1.73m 2 ■=> use half normal dose Q12h    Cr Cl 10-30 mL/min/1.73m 2 ■=> use normal initial dose then half dose  Cr Cl <10 mL/min/1.73m 2 ^ use normal initial dose then one-quarter dose    Bactericidal against aerobic G-ve organisms (e.g. E.coli,  H. influenza. Pseudomonas, and Serratia). Usually used with  ampicillin (empirical) or aminoglycosides (synergistic against  Pseudomonas and Enterobacteriaceae).    Provide adequate amounts of glucose to avoid hypoglycemia;  contains 780 mg L-arginine / g.   Dose (in mEq) based on Base Deficit = 0.3 X Base deficit (mEq/L)  X weight (kg). Give 34 dose then assess need.   Dose (in mEq) based on HCO^ level = 0.5 X[24 - serum HC0 3 ‘  (mEq/L) X weight (kg)]. Give 34 dose then assess need.   Dose in RTA: 2-3 mEq/kg/day in divided doses for type I and type  IV. Proximal RTA (type II) requires larger doses, as high  aslOmEq/kg/day.   Administer IVI by syringe pump over 15 minutes at 24 h interval  Course may be repeated after 48 hours if necessary. BNFC2009   Contraindicated in preterms with infection, active bleeding,  thrombocytopenia or coagulation defects, NEC, significant renal  dysfunction and duct-dependent systemic blood flow.    LD: 20-25 mg/kg IV over 30 min or PO  MD: 5-10 mg/kg/dose Q24h IV slowly or PO    Neonatal Apnea, including post-extubation and post  anesthesia (antagonizes adenosine -*T Respiratory  center output, chemoreceptor sensitivity to C0 2 , smooth  muscle relaxation and COP).    Serum level on D5 of therapy (5-25 pg/mL).  Monitor HR; withdraw if > 180 bpm.  Agitation.    Acute ttt of symptomatic hypocalcemia: 0.35-0.7 mL/kg/dose IV.  Dilute, then infuse over 10-30 min while monitoring for  bradycardia. Stop if HR < 100 bpm.   In exchange transfusion: 0.33 mL/100 mL blood exchanged, IVI  over 10 to 30 min.   Each 100 mg = 1 mL = 26.7 mg elemental Ca   Bradycardia or cardiac standstill with rapid infusion  Bolus infusion by UAC is associated with intestinal  bleeding and lower-extremity tissue necrosis.   Infusion by UVC may result in hepatic necrosis if it is  lodged in a branch of the portal vein.    Acute ttt of symptomatic hypocalcemia: 1-2 mL/kg/dose IV.  Dilute, then infuse over 10-30 min while monitoring for  bradycardia. Stop if HR < 100 bpm.   In exchange transfusion: 1 mL/100 ml. blood exchanged IVI over  10 min.   Each 100 mg = 1 mL = 10 mg elemental Ca   IV calcium solutions are incompatible with NaHC0 3 since calcium  carbonate will precipitate.   Early hypocalcemia is common in asphyxiated infants, PT and  IDM. It may occur also with alkalosis or following exchange  transfusion.   Signs of hypocalcemia include muscle twitching, jitteriness,  generalized seizures, QTc above 0.4 sec.    Initial Dose: 0.01 - 0.05 mg/kg/dose PO Q8-12h. Adjust dose and  interval based on response. Administer 1 h before feeding.    Blood pressure, particularly after the first dose.  Renal function and serum K + .    1 Cerebral blood flow (seizures, apnea, and lethargy).  i Renal blood flow (oliguria).   T K + (primarily in patients receiving K-sparing diuretics or K  supplements).   Contraindicated in patients with bilateral renovascular disease or with  unilateral renal artery stenosis in a solitary kidney.   Digoxin: captopril possibly T plasma concentration of digoxin.  Corticosteroids: hypotensive effect of ACE-i is antagonized.   Diuretics: T hypotensive effect; T risk of severe hyperkalemia with K +  sparing diuretics and aldosterone antagonists (monitor K + concentration  with low-dose spironolactone in heart failure).    For children 1 m - 12 v: 20 mg/kg/day in 3 divided doses,  doubled for severe infection (usual max. 1 g daily). BNFC2009    Acute Otitis Media Infection, H. Influenzae Pneumonia,  Lower Respiratory Infections, Pharyngitis, Pneumonia,  Skin Infection, Strept. Pneumonia, Tonsillitis, URT  Infection, UTI Infections.   Allergic Reactions, Anaphylaxis, Angioedema, Drug Fever,  Erythema, Erythema Multiforme, Elemolytic Anemia,  Elypoprothrombinemia, Pruritus of Skin,  Pseudomembranous Enterocolitis, Renal Disease, Seizure  Disorder, Skin Rash, Stevens-Johnson Syndrome.   Brands include: Totacef® and Zinol® 500 mg and 1 g vials.    It's a bactericidal l st generation cephalosporin, mainly G+ve with  poor CNS penetration.   UTI and soft tissue infections caused by e.g. penicillin resistant  Staph, aureus, Klebsiella, and Proteus.    A 3 rd generation cephalosporin that is active against G-ve  organisms including H. influenza, Enterobacteriaceae, Citrobacter  sp., E. coli, Klebsiella and Proteus.   Active against G+ve organisms such as Staph, aureus, Staph,  epidermidis, strept. pneumonia and Strept. pyogenes.    Keep suspension in the fridge for up to 10 days after  reconstitution.   FT Q6h ... PT > 32 wk GA Q8h ... PT < 32 wk GA Q12h.   Use Perfalgan® either undiluted or dilute to a concentration of 1  mg/mL in D 5 W or NS; use within lh of dilution.    Liver toxicity (if prolonged > 48h or excessive dosing)  Rash, fever.   LD: 150 mg/kg in D 5 W IVI over 30 minutes.   MD: 50 mg/kg IVI over 4h then 100 mg/kg over 16h until clinical and  biochemical markers of hepatic injury improve (e.g. INR normalizes).    Sedative-Hypnotic for short term use only (onset of  action within 10-15 minutes).    Oral preparation should be diluted or administrated after  a feeding to reduce gastric irritation.   Acute overdose: CNS, respiratory and myocardial  depression, cardiac arrhythmias, ileus and bladder atony.  Indirect hyperbilirubinemia.    Dose: 10 mg/kg/dose Q12h Mover 30-60 minutes.  Treatment is usually continued for 10-14 days   Moderate activity against G+ve; Strept. pneumoniae (not used  for pneumococcal pneumonia) and Entercoccus faecalis.  Chlamydia and some mycobacteria.   Fluoroquinolones may damage growing cartilage and cause an  arthropathy. Thus not routinely recommended for patients < 18  years of age. However, since the arthropathy is reversible,  fluoroquinolones may be used in children in some cases (e.g. for  treatment of pseudomonal infections in patients with cystic  fibrosis).    Dose: 50 mg/kg/dose IVI over 30 min, or IM. Dose doubled in  severe infection and meningitis.   the time of delivery: 100 mg/kg/dose IVI over 30 min once.  Gonococcal Infections: 25 mg/kg/dose IVI over 30 min, or IM.    Neonatal meningitis and sepsis by G-ve organisms (e.g. E.coli,  H. influenza, Klebsiella, Pseudomonas)   Adjust dose to maintain anti-factor Xa level between 0.5-1 units/mL.  Low Risk Prophylaxis:    Anti-factor Xa 4h after a dose. After attaining target level, dose  adjustment is needed 1-2 times/month.    Not used for Gl infections by oral route but used for gut  sterilization.    Dose: 6 mg/kg/dose Q12h IVI over lh for a minimum of 6 weeks.    Prevention of progressive hearing loss in babies with  symptomatic congenital CMV infection.    CBC every 2-3 days during 1 st 3 weeks, then weekly if stable.    Significant neutropenia in majority of patients. Reduce the dose  by half if < 500 cells/mm 3 . Stop if not resolved.    Bacteriostatic for bacteremia, pulmonary and deep tissue  infections by anerobic bacteria and some G+ve cocci.   Should NOT be used in ttt of meningitis (poor CSF penetration).    Pseudomembranous colitis (Bloody diarrhea, abdominal pain, and  fever) -♦ discontinue, bowel rest, TPN, oral metronidazole.    Anti-inflammatory used to facilitate extubation and improve lung  function in infants at higher risk for developing CLD.   Gl perforation and hemorrhage occur more in patients treated  beginning in D1 and in those treated concurrently with  indomethacin (don't give them concurrently).   Cardiac effects on D14 include T LV wall thickness with outflow  tract obstruction, transient impairment of LV filling and ST  segment depression.    ACE Inhibitors: corticosteroids antagonise hypotensive effect.  Analgesics:? risk of Gl bleeding and ulceration when given with  NSAIDs.   Antibacterials: metabolism is possibly inhibited byerythromycin.  Antiepileptics: metabolism is acceleratedby phenytoin (reduced  effect)   Diazoxide: corticosteroids antagonise hypotensive effect.  Diuretics: corticosteroids antagonize effect; ? risk of hypokalemia  when given with acetazolamide, loop diuretics or thiazides and  related diuretics.   Vaccines: high doses impair immune response to vaccines, avoid  concomitant use with live vaccines.   Phenadone® Syrup contains 0.5 mg Dexamethasone and  2 mg Chlorpheniramine maleate per 5 mL   Anticonvulsant: 4-16 mg/kg/day PO divided every 6-8h (not to  exceed 30 mg/kg/day or 1 g/day).   To -I CSF production: 5 mg/kg/dose IV or PO Q6h increased by 25  mg/kg/day to a maximum of 100 mg/kg/day. Lasix® may be used  in combination.   Anticonvulsant in refractory neonatal seizures (retards abnormal  discharge from CNS neurons).    Serum electrolytes (contraindicated in iK + and lNa + ).  Plasma pH and Chloride.   Interfere with metabolism of barbiturates and phenytoin,  aminophylline, caffeine, theophylline and midazolam.    Cr Cl <50 mL/min/1.73m 2| => usual initial dose then halve  subsequent doses.   Antiepileptics: fluconazole T plasma concentration of phenytoin  (consider 1 dose of phenytoin); voriconazole t plasma  concentration of phenytoin, also phenytoin i plasma  concentrationof voriconazole (T dose of voriconazole and also  monitor for phenytoin toxicity).   Anxiolytics and Hypnotics: fluconazole T plasma concentration of  midazolam (risk of prolonged sedation).   Barbiturates: plasma concentration of voriconazole possibly i by  phenobarbital - avoid concomitant use.    Each vial contains 38 mg and will bind 0.5 mg digoxin.   Once administered, digoxin serum concentrations can no longer  be determined accurately.    The contents in each vial to be used should be dissolved with 4  mL of Sterile Water for Injection, by gentle mixing, to give a clear,  colorless, approximately isosmotic solution with a protein  concentration of 9.5 mg/mL.   If it is not used immediately, it may be stored under refrigeration  at 2-8°C for up to 4 hours.   If cardiac arrest is imminent, it can be given as a bolus injection.   Unreconstituted vials can be stored at up to 30°C for a total of 30  days.   to 24 mL D 5 W ; Di 0 W, NS or LR ; given as IVI at a rate of 1 mL/h.   10 ng/kg/min dose is equal to 0.29 mL/kg/24h of Dobuject® 250 mg / 5 mL  10 ng/kg/min dose is equal to 1.15 mL/kg/24h of Dobutrex® 250 mg / 20 mL   Incompatible with NaHC0 3 , Insulin and furosemide .  Incompatible with NaHC0 3 , Insulin and furosemide .   Dilute to a concentration of 0.5-1 mg/mL (max. 5 mg/mL if fluid restricted)  with D 5 W or NS; infuse higher concentration through CVC only.    Heart rate and Blood pressure (Peak effect in 10 min).  IV sites for extravasation.    Hypotension if patient is hypovolemic. Volume loading is  recommended before starting dobutamine therapy.   Volume of drug needed per day = DoseX1 ^ XwtX5 then added to  24 mL D 5 W and given as IVI at a rate of 1 mL/h.   5 pg/kg/min is equal to 0.18 mL/kg/24h of Intropin® 200 mg/5 mL   Dilute to a max. concentration of 3.2 mg/mL with Glucose 5% or  Sodium Chloride 0.9%. Infuse higher concentrations through CVC  using a syringe pump to avoid extravasation and fluid overload.   Urine output and peripheral perfusion.  IV sites for blanching and infiltration.   These infusions may be mixed in IV solutions containing  dextrose and/or saline.   IV (or IM): 0.05-0.15 mg/kg over at least 5 minutes, repeat as  required, usually Q2-4h.   IVI: 0.01-0.06 mg/kg/h (T after several days of therapy due to  tolerance or t clearance).   Sublingual: 0.2 mg/kg/dose using injectable form mixed with a  small amount of flavored syrup.   LD: 0.15 mg/kg IV over at least 5 min, followed by  Maintenance IVI: 0.06-0.4 mg/kg/h.    Initial Oral Dose: 10-14 |jg/kg/dose PO Q24h (37.5-50  jig/ dose for an average term infant). Dosage is adjusted  in 12.5 |jg increments.    Serum T 4 level after 2 weeks of treatment (10-16 pig/dL in the  first year of life). T 3 level should be normal (70-220 ng/dL) and  TSH should have declined from initial value.   After 12 weeks of treatment, serum TSH should be in the normal  range < 15 mll/L.   Measure T 4 and TSH at 2 weeks of age, then every 1-2 months or  2 weeks after any change in dosage.   Signs of hypothyroidism: lethargy, poor feeding, prolonged  neonatal jaundice, constipation, intermittent cyanosis.   Signs of thyrotoxicosis: hyperactivity, altered sleep pattern,  tachycardia, tachypnea, fever, exophthalmos and goiter.   Phenytoin IV 250 mg / 5 mL  Phenytoin PO 30 mg / 5 mL   Maximum rate of infusion 0.5 mg/kg/min  Infusion solution concentration 5 mg / mL  Incompatible with D 5 W, Di 0 W.   Serum therapeutic level is 6-15 pg/mL in the 1 st weeks, then 10-  20 pg/mL due to change in protein binding.   Bilirubin displaces phenytoin from protein-binding sites, resulting  in increased free drug.   With long term therapy: Arrhythmias, hypotension, gingivitis,  nystagmus, rickets, hyperglycemia, and hypoinsulinemia.    Dose: 200-400 iu/kg/dose, 3-5 times per week for 2 to 6  weeks. Total dose per week is 600-1400 iu/kg   Administer SC or IVI (over > 4h or continuously in TPN).   For IVI: Dilute in 2 mL of solutions containing at least 0.05%  protein and infuse over 4 hours. Stable for 24h.    Stimulate erythropoiesis and i the need for PRBCs transfusion in  high risk preterms.   The most likely to benefit are ELBW < 800 gm with phlebotomy  losses > 30 ml/kg.   trachomatis Conjunctivitis and Pneumonitis: 12.5 mg/kg/dose  PO Q6h for 14 days.   Feeding intolerance due to dysmotility: 10 mg/kg/dose POQ6h  for 2 days followed by 4 mg/kg/dose PO Q6h for 5 days.    Infections by Chlamydia, Mycoplasma, and Ureaplasma.  Treatment and prophylaxis for Bordetella pertussis.   xlOt risk of hypertrophic Pyloric stenosis in neonates under 2  wks of age.    Sedation and Analgesia: 0.5-4 pg/kg/dose IV slow push,  repeat as required, usually Q2-4h.   For a dose of 2 pg/kg, give 1 mL/kg  Stable for 24h refrigerated after dilution.    Respiratory and cardiovascular status.  Abdominal distension, loss of bowel sounds  Muscle rigidity.    Respiratory depression with anesthetic dose > 5 pg/kg.  Chest wall rigidity with laryngospasm, reversible with  naloxone.    For growing PT infants: 2 mg/kg/day (max. 15 mg/day),  begin after 2 weeks of age.    In growing PT infants, iron supplementation should not  be started until adequate vitamin E is supplied in diet:  otherwise iron may t hemolysis.    LD:15 mg/kg PO or IVI over lh  MD: 7.5 mg/kg/dose PO or IVI over lh    Reduce total daily dose to one third and give once daily  Use with caution in hepatic encephalopathy    Meningitis, ventriculitis and endocarditis caused by  Bacteroides fragilis and other anaerobes resistant to  penicillin.    May mask hematological defects of Vit Bi 2 deficiency, but  it will not prevent the progression of irreversible  neurologic abnormalities.   May decrease phenytoin serum concentration.  Contraindicated in pernicious, aplastic and normocytic  anemia    Neonatal meningitis and sepsis by G-ve organisms (e.g.  E.coli, H. influenza, Neisseria, Klebsiella, and Proteus  species), esp. Pseudomonas aeruginosa.   - MD: 0.5-1 mg/kg IVI over 2-6h Q24-48h for 2-6 wks or longer.   T K + and Mg loss due to tubular injury, 1 reabsorption of Na. Na  intake > 4 mEq/kg/day may prevent nephrotoxicity.   Discontinue if BUN > 40 mg/dL, serum creatinine is > 3 mg/dL, or  liver function tests are abnormal.   If creatinine increases > 0.4 mg/dL during therapy, hold dose for  2-5 days.    Antibacterials: T risk of nephrotoxicity when given with  aminoglycosides; possible T risk of nephrotoxicity when  amphotericin given with vancomycin.   Diuretics: T risk of hypokalemia when given with loop diuretics or  thiazides.    Aerobic G-ve Bacilli(e.g. Pseudomonas, Klebsiella, E.coli). Usually  used in ombination with a (3-lactam antibiotic.    Transient and reversible renal tubular dysfunction (T urinary loss  of Na, Ca, and Mg).   Increased neuromuscular blockade when used with pancuronium  and in patients with hypermagnesemia.    Obtain peak concentration 30 minutes after end of infusion and  trough level just prior to the next dose, refrigerate blood sample soon  Peak: 5-12 pg/mL  Trough:0.5-lpg/mL    Short-term (< 8 weeks) treatment of documented reflux  esophagitis or duodenal ulcer refractory to conventional  therapy. Onset of action within lh with duration of  action of 72h.    Symptomatic improvement within 3 days.  Intra-esophageal pH monitor to assess efficacy (pH >  4.0).   Each 5 mL contains 5 g sodium alginate + 2.5 gm NaHC0 3    NaHC0 3 may, by acting as an antacid, control some of the symptoms  of gastro-oesophageal reflux.   Alginate reacts with gastric acid to form a viscous gel or 'raft' that  then floats to the top of the stomach, acting as a mechanical barrier to  oesophageal reflux.    Each dose of Gaviscon® infant Sachets contains 225 mg of sodium alginate  and 87.5 mg magnesium alginate.   < 4.5 kg, one dose and 2 doses if > 4.5 kg   Add 5 mL of cooled boiled water to the powder in a glass. Mix to a  smoothpaste and add another 10 mL water and mix.   < 4.5 kg, one dose to be mixed into not less than 115 mL of each feed in  thebottle and shaken well.   > 4.5 kg, 2 doses to be mized into not less than 225 mL of each feed in  thebottle and shaken well.   Treatment of Thrombosis: 75 units/kg bolus, followed by  28 units/kg/h IVI   - Adjust dose to achieve aPTT of 60-85 seconds  (corresponds to an anti-factor Xa level of 0.3-0.7).    Platelet count every 2-3 days.  aPTT (achieve aPTT of 60-85 seconds).  Signs of bleeding and thrombosis.   Contraindicated in infants with evidence of intracranial  or Gl bleeding or thrombocytopenia (<50. 000/mm 3 ).    IV: begin with 0.1 - 0.5 mg/kg/dose Q6-8h. Increase gradually as  required to a maximum of 2 mg/kg/dose Q6h.   PO: 0.25-1 mg/kg/dose Q6-8h, or approximately twice the required IV  dose. Administer with food to enhance absorption.   To prepare an oral suspension, crush a 50 mg tablet in 4 mL of 5%  mannitol then add 46 mL of sterile water to make a final concentration  of 1 mg/mL. Stable for 7 days refrigerated.   NOTE: use with BB T the anti-hypertensive effect and i the magnitude  of the reflex tachycardia. This is expected to reduce hydralazine  requirements to < 0.15 mg/kg/dose.   Tachycardia, postural hypotension, headache, nausea, and a  lupus-like syndrome (10-20% of adults).   Gl irritation, bleeding, drug fever, rash, conjunctivitis, and bone  marrow suppression (in adults, uncommon).   0.01 - 0.02 mL/kg/min over 30 minutes  then the rest of the amount over 1 / h.    Rate/h in 1 st 30 min = 0.02 X Wt (Kg) X 60   Available as lg in 20 mL- 2.5 g in 50 mL- 5 g in 100 mL    Adjuvant treatment of fulminant neonatal sepsis,  hemolytic jaundice, neonatal alloimmune  thrombocytopenia.    Closure of PDA: as table IVI over at least 30 minutes. Usually 3  doses per course, maximum 2 courses.   Give at 12-24h intervals with close monitor to UOP, if anuria or  severe oliguria, delay subsequent dose.   Prevention of IVH: 0.1 mg/kg Q24h, 3 doses start at 6-12h of age.   Stable for 12d when stored at room temperature or refrigerated.  Compatible with sterile water, D2.5W, D 5 W and NS.    If oliguria occurs, observe for hyponatremia and hypokalemia and  consider prolonging the dosing interval of renally excreted drugs.  Consider withholding feedings.   Contraindicated in active bleeding, significant thrombocytopenia  or coagulation defects, NEC and significantly impaired renal  function.   Antibacterials: indometacin possibly T plasma concentration of  amikacin and gentamicin in neonates; possible t risk of  convulsions when given with quinolones.   Antiepileptics: NSAIDs possibly T effects of phenytoin.  Beta-blockers and Calcium-channel Blockers: NSAIDs antagonise  hypotensive effect.   Diuretics: risk of nephrotoxicity of NSAIDs ! by diuretics, also  antagonism of diuretic effect; indometacin antagonises effects of  diuretics; ! risk of hyperkalemia when given with K + -sparing  diuretics and aldosterone antagonists.    Starting IV Dose: 0.01 mg/kg Q6h over 10 min. Increase as needed to a  maximum of 0.15 mg/kg/dose Q6h.   Starting Oral Dose: 0.25 mg/kg/dose Q6h. Increase as needed to  amaximum of 3.5 mg/kg/dose Q6h.   SVT especially if associated with Wolff-Parkinson-White syndrome.  Palliation of TOF and HOCM.   Blood glucose during initiation of treatment and after dosage changes.  Assess for increased airway resistance.    Hypotension, bradycardia, bronchospasm and hypoglycemia.  Contraindicated in patients with reactive airway disease or diminished  myocardial contractility.   A withdrawal syndrome (nervousness, tachycardia, sweating, hypertension)  with sudden cessation of the drug.   Hypotensive effect of beta-blockers antagonised by corticosteroids.  Diazoxide: enhances hypotensive effect.   Thyroid Hormones: metabolism of propranolol is accelerated.  Hydralazine: enhance hypotensive effect.    Continuous IVI: 0.01-0.1 unit/kg/h  Intermittent SC dose: 0. 1-0.2 unit/kg Q6-12h.   For hyperkalemia: begin with a bolus of insulin (0.05 u/kg) with 2  mL/kg of Di 0 W followed by IVI of D i0 W at 2-4 mL/kg/h and  regular insulin (0.1 u/mL) at 1 mL/kg/h. The two solutions may be  prepared individually to allow adjustments in infusion rate in  response to hyper- or hypoglycemia.   For IVI: Mix 15 units in 150 mL NS or D 5 W (final concentration of  0.1 u/mL; maximum concentration is 1 u/mL). Flush tubing with  25 mL of insulin solution before beginning the infusion.   Gomella 2009: to 1 absorption of insulin to IV solution bag or  tubing, flush the line with solution, wait 30 min then flush the  line again with solution prior to initiation. The actual amount of  insulin being administrated could be less than the apparent  amount. So, adjustment of the insulin rate should be based on  the effect and not solely on the apparent insulin dose.   For SC administration: Dilute to 0.5 - 1 U/mL DW or NS.   - Glucose > 250 mg/dL despite 1 GIR by 2 mg/kg/min Q4-6h.    Blood glucose concentration Q15-30 minutes after starting  infusion and after changes in infusion rate.   Euglycemic hyperinsulinemia may cause metabolic acidosis.  1 Glucose level gradually to avoid rapid fluid shifts.   For PO use: Dilute in 3-4 mL fluid per g of resin; 10%  sorbitol, water, or syrup may be used as diluent.   For PR use: Dilute in water or 25% sorbitol at a  concentration of 0.3-0. 5 g/mL; retain enema for at least  30-60 min or several hours if possible  The Na + content is -100 mg/g (4.1 mEq/g) of the drug  Also available as Sorbisterit® (calcium polystyrene sulfonate)    Clarithromycin acts like erythromycin and has a similar  spectrum of antibacterial activity i.e. mainly against G+ve  organisms, although it is usefully more active against  Haemophilus influenzae.   It's used for respiratory tract infections including atypical  pneumonias and soft tissue infections.    Macrolides are enzyme inhibitors and interfere with the  metabolic inactivation of some drugs, e.g. theophylline,  increasing their effects.   Infants receiving TPN and infants receiving antibiotics for  > 2 weeks should be given at least 0.5 mg of vitamin Ki  (IM or IV) weekly to prevent vitamin K depletion.   Vitamin Ki may require 3h or more to stop active  bleeding so FFP (10 mL/kg) may be necessary when  bleeding is severe.   (300 mg / ml Oral Liquid) or (1 g / 5 ml IV)   PO: 50 mg/kg Q12h, higher doses up to 200 mg/kg daily  occasionally required.   I VI : initially 100 mg/kg over 30 minutes followed by a  continuous infusion of 4 mg/kg/h.   Slow IV injection over 2-3 minutes: 100 mg/kg/daily in  2-4 divided doses    L-Carnitine is used in the management of a range of rare  genetic conditions associated with carnitine deficiency.   It is essential for the entry of long-chain fatty acids into  the mitochondria, where they are oxidized.   Side-effects may be dose-related - monitor tolerance  during first week and after any dose increase.    Heart failure caused by diminished myocardial contractility.  SVT, atrial flutter and AF.    HR, Rhythm and Periodic ECG (assess desired effects and signs of  toxicity).   Serum K + , Ca, Mg (esp. with diuretics or amphotericin B); 1K + ,   Renal function and Therapeuric serum level (1-2 ng/mL).  Be aware of drug interactions.    ACE Inhibitors: plasma concentration possibly T bycaptopril.  Analgesics: plasma concentration possibly t by NSAIDs, also  possibleexacerbation of heart failure and reduction of renal  function.   Antibacterials: plasma concentration possibly T by gentamicin  and trimethoprim; plasma concentration possibly i by rifampicin;  plasma concentration t by macrolides (T risk of toxicity).  Antiepileptics: plasma concentration possibly 1 by phenytoin.  Amphotericin: T cardiac toxicity if hypokalemia occurs.  Corticosteroids: T risk of hypokalemia.   Diuretics: T cardiac toxicity if hypokalemia occurs with  acetazolamide, loop diuretics or thiazides and related diuretics;  plasma concentration T by spironolactone.   Initial intervals: PT Q24h - FT Q12h - FT > lm Q6-8h  Consider alternate-day therapy for long term use.   Acidic solutions (pH < 5.5) as D 5 W, Di 0 W cause Lasix® to degrade  when they are mixed for several hours.    1 K + may precipitate coma (K + -sparing diuretics prevent this).   Assess for K + depletion in patients receiving digoxin concurrently.  Follow weight changes.   Cholelithiasis (in patients with BPD or CHD who received long-  term TPN and lasix).    Starting Dose: 0.5 g/kg/day IV Increased By: 0.5  g/kg/day Maximum 3g/kg/day- Infusion rate: should not  >0.15 g/kg/hr - 24h infusion time is preferred.   Use minimum dose in severe hyperbilirubinemia, sepsis  or severe pulmonary dysfunction.   LD: 0.25 mL (0.2 mEq)/kg/dose IV or IM q6h until the serum  magnesium level is normal or symptoms resolve, or 0.8-1. 6  mEq/kg/dose PO 4 times daily.   MD: 0.25-0.5 mEq/kg/24 h IV (add to infusion or give IV).   LD: 200 mg = 2 mL = 1.6 mEq/kg IVI over 20-30 min  MD: 20-75 mg= 0.2-0.75 mL = 0.16-0.6 mEq/kg/h IVI to maintain  plasma-Mg concentration between 8.5-13.4 mg/dL (3. 5-5. 5 mmol/L),  given for up to 5 days.   1 mL MgS0 4 10 % = 100 mg Mg = 0.8 mEq Mg    Monitor serum magnesium, calcium, and phosphate levels.  Infuse IV magnesium sulfate over several hours.   Each 5 mL contains: 150 mg elemental calcium, 173.25 mg  magnesium and 100 IU Vit D 3 .   Each 2.5 mg Ca Carbonate contains: 1 mg elemental Ca.  Each 5 ml of Hi-Cal® contains: 1.2 gm calcium glubionate  equivalent to 87 mg elemental calcium.    Non-acute hypocalcemia in babies able to tolerate oral  medications (absorption in small intestine).   Use with caution in infants who are at risk for NEC.  Interferes with absorption of levothyroxine.   4xLui ^ Y / 4-C.Loj > i j , i~i i _Lo _Li ... * ("/ 0 ^ Y 0/ ^ ) (CuJ-MkS'Lj    G-ve organisms (e.g. E.coli, H. influenza, Enterobacter,  Klebsiella, Morganella, Neisseria, Serratia and Proteus  species), esp. Pseudomonas aeruginosa that is resistant  to 3 rd generation cephalosporins.   G+ve organisms (e.g. Strep pneumonia, Strep pyogenes.  Strep agalactiae and Staph aureus).    Cr Cl 26-50 mL/min/1.73rri ^ use normal dose Q12h  Cr Cl 10-25 mL/min/1.73m 2( =!> use half normal dose Q12h  Cr Cl <10 mL/min/1.73m 2c I> use half normal dose Q24h    Pneumococcal meningitis and other G-ve organisms  resistant to other antibiotics, especially extended  spectrum p-lactamase producing Klebsiella pneumoniae.   MD (8-12h Later): 1.5-3 mg/kg/dose PO or IV slow push Q8-12h.   If>55 wks PMA: Tdose to 25-30 mg/kg/day in divided doses Q4-8h   ' n ... * (|A 1 + jc-wj \) (|C-u) \ • / TO • )   Therapeutic level in apnea of prematurity 7-12 pg/mL and in  bronchospasm 10-20 pg/mL.    Signs: sinus tachycardia, failure to gain weight, vomiting, jitteriness,  hyperreflexia and seizures.   Treatment: activated charcoal 1 g/kg by gavage tube Q 2-4h. Avoid  sorbitol-containing preparations; may cause osmotic diarrhea.    Dose: 0.05-0.2mg/kg/dose IV over at least 5 minutes, repeat as  required, usually Q4h.   Opioid dependence: begin at most recent IV morphine dose  equivalent. Taper to 10-20% per day as tolerated. PO dose is ~ 3-5  times IV dose.   Initial treatment of neonatal narcotic abstinence: 0.03-0.1  mg/kg/dose PO Q3-4h. Wean dose by 10-20% every 2-3 day based on  abstinence scoring (the Finnegan score should be <9). Use the 0.4  mg/mL oral morphine solution   A 0.4 mg/mL oral morphine solution may be made by adding 0.4 mL of  concentrated injectable solution to 9.6 mL of NS.    Respiratory and cardiovascular status.  Abdominal distension, loss of bowel sounds  Consider urine retention if UOP is decreased    PO: 1 mL (PT) to 2 mL (FT) divided and applied with swab  to each side of mouth Q6h. Continue for 3 days after  symptoms have subsided.   Topical: Apply Q6h. Continue for 3 days after symptoms  have subsided.   Doses needed to reverse narcotic induced depression  may be as low as 0.01 mg/kg.    Narcotic antagonist (onset within minutes after IV dose  and within lh, if given IM).   Adjuvant therapy for customary resuscitation efforts for  narcotic-induced respiratory (CNS) depression.   Tobrin® or Tobrex® 0.3% Ophthalmic use: instill 1-2 drops into  each eyeQ4h or more often if severe infection, or apply a small  amount of ointment into each eye 2-3 times/day or for severe  infections Q3-4h.    Aerobic G-ve Bacilli (e.g. Pseudomonas, Klebsiella, E.coli). Usually  combined with a |3-lactam antibiotic (in separate infusion).    Transient and reversible renal tubular dysfunction (T urinary loss  of Na, Ca, and Mg).   Increased neuromuscular blockade when used with pancuronium  and in patients with hypermagnesemia.   \ • • (jcJj-MijI C)lIo_j_u) ...) ((«_ui / V • • ) (jo-jaij   BNFC 2009: for SC or IV injection or infusion, dilute with D 5 W to a  concentration not less than 15 pg/mL (concentration of 100  pg/mL are adequate for SC use in neonates); to dilute to 2-15  pg/mL, add albumin solution to produce a final albumin solution  of 2 mg/mL; not compatible with NaCI solutions.    Filgrastim enhances the production and release of WBC from  bone marrow. Whether this cytokine can be effective, either  prophylactically or therapeutically, in combating neonatal  bacterial and fungal infection remains to be established.    Dose: 20-100 nanograms(base)/kg/min IVI adjusted according to  response; max. 1 pg(base)/kg/min.   4-cLmi Y 1 ^ Jj jj * ('/.0 ^ j«_ui 0 • + (O-uj ... ) (|C-ui ^ ^ ) (jULuj.il jjj   Dilute 600 pg (base)/kg to a final volume of 50 mL with infusion fluid  (D 5 W or NS); an IVI rate of 0.1 mL/hr provides a dose of 20  nanograms(base)/kg/min. Infuse through CVC; discard if  discoloured.   1 mg of noradrenaline acid tartrate is equivalent to 500 micrograms  of the base. Dose expressed as the base.    Dose: as table. Divide dosage and administer PO 2-3 times per day.    Dose in infants 15 d - 6m: 4 mg/kg/dose PO Q12h. BNFC2009    Upper respiratory tract infections (but in pharyngitis and  tonsillitis reserved for infections which are recurrent, chronic, or  resistant to other antibacterials).    GFR 10-40 mL/min/1.73m 2 ■=> T dose interval to Q24h.  GFR <10 mL/min/1.73m 2 dose interval to Q48h.   Allergic Reactions, Anaphylaxis, Angioedema, Drug Fever,  Erythema, Erythema Multiforme, Hemolytic Anemia,  Hypoprothrombinemia, Pruritus of Skin, Pseudomembranous  Enterocolitis, Renal Disease, Seizure Disorder, Skin Rash, Stevens-  Johnson Syndrome.    Keep suspension in the fridge for up to 10 days after  reconstitution.    Menengitis: 75,000 to 100,000 units/kg/dose IVI over 30 min or IM  Bacteremia: 25,000 to 50,000 units/kg/dose IVI over 15 min or IM   Congenital Syphilis: 50,000 units/kg/dose IVI over 15 min Q12h for  1 st 7d then Q8h. Treat for 10-14d.   Na content is 2 mEq per 1 million units (600 mg).   Serum Na + and K + when using high doses with RF.    1-5 mL of a 1 mg/mL solution is injected SC into affected area  (depending on the size of the infiltrate).    Alpha-blocker agent used for prevention of dermal necrosis and  sloughing caused by extravasation of vasoconstrictive agents e.g.  dopamine.   Consider using topical 2% nitroglycerin ointment if affected  extremity is significantly swollen.   5,000-8,000 lU/day of Vit-  D 2 or 3-5 pg/kg/day of 25-  hydroxycholecalciferol   2. 5-5.0 mg every other day  as water-soluble derivative  of menadione    Initial oral replacement therapy: 0.5-1 mEq/kg/day divided and  administrated with feedings.   Acute treatment of symptomatic hypokalemia: begin with 0.5-1  mEq/kg IV over 1 hour then reassess.   The injectable form may be given in divided doses PO and diluted  in the infant's formula.   Maximum Peripheral IV solution concentration 0.04 mEq/mL.  Maximum Central IV solution concentration 0.08 mEq/L.   1 mEq K + = 74.6 mg KCI (0.5 mL KCI 15%)    Arrhythmias (peaked T-waves, widened QRS, flattened P waves,  bradycardia, heart block and cardiac arrest).   Effects of lK + include neuromuscular weakness, paralysis, ileus,  urine retention, ECG changes (ST depression, low voltage T-wave,  appearance of U wave) and T digitalis toxicity.    Myasthenia gravis: 0.1 mg IM. Given 30 min before  feeding. 1 mg PO (Given 2h before feeding). Dose may be  increased.   Reversal of neuromuscular blockade: 0.04-0.08 mg/kg  IV. In addition to atropine 0.02 mg/kg.    Neonatal transient or persistent (congenital) myasthenia gravis  Reversing effects of neuromuscular blocking drugs.   mL D 5 W or NS and given as IVI at a rate of 1 mL/h.   Minimum Infusion solution concentration 10 pg/mL.  Maximumlnfusion solution concentration 20 pg/mL.   Must be refrigerated. Prepare fresh infusion solutions every 24h.  Compatible with dopamine, epinephrine, furosemide, heparin,  midazolam and KCI.    Promote dilatation of ductus arteriosus in infants with CHD  dependent on ductal shunting for oxygenation/perfusion.  Maximum effect seen within 30 min in cyanotic lesions, may take  several hours in acyanotic lesions.   - Apnea (consider treatment with aminophylline), seen most  often in neonates < 2kg at birth and usually appears during the  1 st h of drug infusion.   - Hypokalemia with long term therapy (> 20 days), especially  with doses > 0.05 pg/kg/min.   - Gastric outlet obstruction and reversible cortical proliferation  of long bones after prolonged ttt (> 120h).   - Pretibial and soft tissue swelling of the extremities may occur  after 9 days of therapy.   - Cortical hyperostosis and periostitis may occur with long term  use (>3 months).   30-60 min: 0.5-0.75 mg / 100 units of heparin given  60-120 min: 0.375-0.5 mg / 100 units of heparin given  >120 min: 0.25-0.375 mg / 100 units of heparin given  Maximum dose: 50 mg  IV Infusion rate should not > 5 mg/min.    Excessive doses can cause serious bleeding problems  Hypotension, bradycardia, dyspnea, and transitory  flushing (in adults).   Postnatal steroid treatment should only be considered in  babies who are ill and ventilator dependent more than a  week after birth.    Should be given to all children before hospital discharge (can be  delayed if the mother is a documented HBsAg -ve)   If mother is HBsAg +ve -► Give HepB and 0.5 mL of HBIG within  12 h of birth   If mother's HBsAg status is unknown -♦ Give HepB within 12 h  and determine HBsAg status as soon as possible and if +ve -»  Administer HBIG (no later than 1 week)    When given at the same time as the first dose of HepB -* Use a  separate syringe and a different site   Draw back on the plunger of the syringe before injection to be  certain the needle is not in a blood vessel   Use universal precautions with neonates born to HBsAg +ve  mothers until they have been bathed carefully    Prophylactic for high risk contacts  of invasive H. influenza type b    Used in combination with vancomycin or aminoglycosides for ttt  of persistent staphylococcal infection.   Potent CP450 enzyme inducer; l Effect of aminophylline,  fluconazole, midazolam, morphine, Phenobarbital, phenytoin,  propranolol and zidovudine.   In Uncomplicated Gonococcal Ophthalmia: 50 mg/kg (maximum  125 mg) single dose.    Neonatal sepsis and meningitis by G-ve organisms (e.g. E.coli,  Pseudomonas, Klebsiella, H. influenza).    Not recommended for use with hyperbilirubinemia ; it displaces  bilirubin from albumin binding sites.   Concurrent use of Ca-Containing solutions in not recommended  within 48h of the last administration of ceftriaxone.   Diarrhea, transient GB precipitations (± colicky abdominal pain,  nausea and vomiting), T AST, ALT.  t BUN and serum creatinine.   Ventolin® Farcolin®5 mg / mL  Salamol® 5 mg / 2.5 mL    DOSE: 0. 1-0.5 mg (0.02-0.1 mL)/kg/dose Q2-6h via nebulizer.  £0:0. 1-0.3 mg/kg/dose Q6-8h.   Continuous ECG monitor. Stop if HR > 180 bpm.  Serum K*.    Dose: 21 mg with or after each feed (max. 6 doses in 24h); may  be added to bottle feed    Dose: 2.5mL with or after each feed (max. 6 doses in 24 hours);  may be added to bottle feed.    Physiologic replacement: 7-9 mg/m 2 /day iv or PO in 2-3 doses  Stress Dose (pressor and volume resistant hypotension): 20-30   mg/m 2 /day IV in 2-3 doses or ~ 1 mg/kg/dose Q8h.  Chorioamnionitis-exposed ELBW infants: 0.5 mg/kg/dose IV  Q12h for 9 days, then 0.25 mg/kg Q12 hfor 3 days.   Pressor-resistant hypotension ( T BP within 2h of 1 st dose)  Adjunctive therapy for persistent hypoglycemia  1 Risk of CLD in ELBW infants exposed to chorioamnionitis.   Hypertension, salt and water retention,  t Risk of Gl perforation when used with indomethacin.  t Risk of disseminated Candida infections.    LD: 20 mg/kg IV slowly over 10-15 min, with refractory seizures  add 5 mg/kg doses, up to a total of 40 mg/kg.   MD: 3-4 mg/kg/day (12-24 after LD) IV, IM, PO or PR. Given daily  (Q12h probably unnecessary).   Y 2 fQj (J^J Y * (/O ^ (O-oi Y" + (O-oj ^ ) ((O-o) / (O-^a 1 • ) lo-dL i o-o^-o)  ^ * * (jdj-ofcjl 4j%j^-o<J 4loj_o> ... <LcLo> ' Y _L*J (OJ 1 l _gva-9l _L (Q.y JS3   (ojJL) 4 xLo) N Y / (O-oj ... * (jO_o) 0 / (OJxlo ^ o) i_j|j-o) LlJL U -o J-P)   May improve outcome in severely asphyxiated infants, used prior  to onset of seizures (40 mg/kg IVI over lh)   May enhance bile excretion in patients with cholestasis before  99 Tc-IDA scanning.   Altered (usually T ) serum concentrations if used with phenytoin  or valproate.   Respiratory depression at serum level > 60 pg/mL.  Irritating to veins.   chloramphenicol, doxycycline and metronidazole (1 plasma  concentration); phenobarbital possibly i plasma concentration of  rifampicin.   Plasma concentration of phenobarbital often T by phenytoin,  plasma concentration of phenytoin often 1 but may be T.  Barbiturates possibly i plasma concentration of propranolol.  Cardiac Glycosides: barbiturates accelerate metabolism of  digitoxin (reduced effect).   Diuretics:! risk of osteomalacia when phenobarbital given with  carbonic anhydrase inhibitor.   Thyroid Hormones: barbiturates accelerate metabolism of  thyroid hormones (may T requirements for thyroid hormones in  hypothyroidism).    In combination with other diuretics in treatment of CHF and BPD  (situtions of increased aldosterone secretion).   Addition of spironolactone to thiazide diuretic therapy in BPD  may yield little, if any, additional benefit.    Serum K + in long term therapy (discontinue if T).  Measuring urinary K + is a useful indicator of effectiveness.   Monitor K + concentration; high risk of hyperkalemia in RF  Avoid if rapidly deteriorating or severe renal impairment.    DOSE: 4 mL/kg/dose, intratracheally, divided into 4 aliquots,  given as soon as possible after birth, preferably within 8 hours of  birth; may be repeated within 48h at intervals of at least 6h for  up to 4 doses.   It is an off-white to light brown liquid supplied in single-use glass  vials containing 4 mL (100 mg phospholipids) or 8 mL (200 mg  phospholipids).   Impaired gas exchange caused by blockage of the airway.  Frequent assessment of oxygenation / ventilation.    If infant becomes dusky or agitated, HR slows, 0 2 saturation falls  > 15% or surfactant backed up in the ETT, dosing should be  slowed or halted.   Warm the vial by standing at room temperature for at least 20  minutes or warm in the hand for at least 8 minutes. Artificial warming  methods shouldn't be used. If a prevention dose is to be given,  preparation of Survanta® should begin before the infant's birth.  Unopened vials of Survanta® that have been warmed to room  temperature may be returned to the refrigerator within 24h of  warming, and stored for future use. Survanta® SHOULD NOT BE  REMOVED FROM THE REFRIGERATOR FOR > 24 h. Survanta® SHOULD  NOT BE WARMED AND RETURNED TO THE REFRIGERATOR > ONCE.   Survanta® is administered intratracheally by instillation through a 5-F  end-hole catheter. The length of the catheter should be shortened so  that the tip of the catheter protrudes just beyond the end of the ET  above the infant's carina. Survanta® should not be instilled into a  mainstem bronchus.   The catheter can be inserted into the infant's by briefly disconnecting  the ET from the ventilator. After administration of each quarter-dose,  the catheter is removed and the infant is ventilated for at least 30  seconds until stable.   To ensure homogenous distribution of Survanta® throughout the  lungs, each dose is divided into four quarter-doses. Each quarter-dose  is administered with the infant in a different position. The  recommended positions are:   - Head and body inclined 5-10° down, head turned to the right   - Head and body inclined 5-10° down, head turned to the left   - Head and body inclined 5-10° up, head turned to the right   - Head and body inclined 5-10° up, head turned to the left    Dose: 24 mg/kg/24h PO in the 1 st week of life then Q12h.  Pneumocystis carinii pneumonia: 24 mg/kg Q6h PO in babies > 4  wks.   It has been used to treat uncomplicated malaria, and also used in  meningitis because of good tissue and CSF penetration.  Respiratory and urinary tract infections   Severe systemic infection, possible combined immune deficiency,  or overt HIV, to reduce the risk of bacterial infection.    Co-trimoxazole increases the plasma half life of phenytoin.  Risk of haemolytic anaemia in babies with G6PD deficiency   If GFR < 15 mL/min/1.73m 2 or if plasma level of sulfamethoxazole  can't be monitored ■=> Avoid.    Dose: 16 mg/kg LD IV followed by 8 mg/kg IV or IM once Q24h.  Treat proven septicemia for at least 7 days.    Teicoplanin is active against many G+ve anerobes and is particularly  potent against Clostridium species. It is also active against most  Listeria, enterococci and staphylococci (including MRSA) although it  may work more as a bacteriostatic drug than as a bactericidal drug.  Vancomycin resistant organisms are sometimes sensitive to  teicoplanin.   Renal and auditory function on prolonged administration during renal  impairment or if other nephrotoxic or neurotoxic drugs given.   Use half normal dose if estimated GFR is 40-60 mL/min/1.73m 2  Use 'A normal dose if estimated GFR is < 40 mL/min/1.73m 2    Non-CNS infections, caused by susceptible (3-lactamase  producing bacteria (e.g. E. coli, Enterobacter, Klebsiella, H.  Influenzae, Proteus mirabilis, Pseudomonas spp., and Staph.  Aureus. Also effective against group B Streptococcus.    Non-CNS infections caused by bacteria, primarily  Enterobacteriaceae and anaerobes, resistant to other antibiotics.  Broad-spectrum of activity includes many G+ve and G-ve bacteria  and anerobes; Imipenem has good activity against Pseudomonas  aeruginosa. Not active against MRSA and Enterococcus faecium.    Not licensed for use in children with renal impairment  Cr Cl <70 mL/min/1.73m 2c: >Reduce dose    Seizures in patients with meningitis, preexisting CNS pathology,  and severe renal dysfunction.    Broad-Spectrum bactericidal against GBS, Listeria monocytogenes  and susceptible E. coli species.    Reduce dose or frequency if estimated GFR < 10 mL/min/1.73m 2 .  Rashes are more common.    Very large doses may result in CNS excitation or seizure activity.  Hypersensitivity reactions are rare in neonates (maculopapular  rash, urticarial rash or fever).    Avoid in chronic liver disease (but used in primary biliary  cirrhosis).   IV form can be used to prepare solution for oral administration.    Bactericidal against aerobic and anerobic G+ve bacteria including  multi-resistant Staph. However, there are reports of Staph,  aureus with i susceptibility. There are T reports of glycopeptide  resistant Enterococci.   Rash and hypotension (red man syndrome), resolves within  minutes to hours-* T infusion time.    Should be measured after 3-4 doses if renal function normal,  earlier if renal impairment.   Trough: 5-10 pg/mL - 15-20 pg/mL when treating MRSA  pneumonia, endocarditis or bone/joint infections (Draw 30  minutes prior to scheduled dose).   Peak: 30-40 pg/mL when treating meningitis (Draw 30 minutes  after end of infusion).    General Anaesthetics: hypersensitivity-like reactions.  Aminoglycosides: T risk of nephrotoxicity and ototoxicity.  Amphotericin: possible T risk of nephrotoxicity.   If staphylococci exhibit tolerance to the drug, combine it with an  aminoglycoside, with or without rifampicin.    Slow IV: 0.3-0. 4 mg/kg repeated once after 10 min if necessary.  PR: 1.25-2.5 mg repeated once after lOmin if necessary.   Available also as Stesolid Rectal Tubes®2. 5-5-10 mg per tube.  Brands include: Epival® and Neuril®.    Close observation is required until full recovery from sedation.  When given IV, facilities for reversing respiratory depression with  mechanical ventilation must be at hand.   Gastro-intestinal disturbances, incontinence, urinary retention.  Blood disorders and jaundice reported; skin reactions. 
PharmacologyByLipincott Neonates Drugs_djvu.txt