Dosages and dosing schedules of common antimicrobials in IEI
| Antimicrobial . | Dosage . | Comments . |
|---|---|---|
| TMP/SMX | 5 mg/kg/day TMP component, divided twice daily; max dose 160 mg TMP 5 mg/kg TMP component divided twice daily 3 days/wk | Twice daily dosing for bacterial prophylaxis in CGD, HIES; consider for PADs 3 days/wk dosing for PJP prevention in SCID, athymia, CID at risk (e.g., Hyper IgM syndrome) Monitor for cytopenias; Folinic acid can minimize risk Consider atovaquone or pentamidine as alternatives for PJP prevention |
| Azithromycin | 5 mg/kg/day; max dose of 250 mg daily or 5 mg/kg/day or 500 mg 3 days/wk | Check EKG for QTc interval and consider hearing screen Monitor for resistance with long-term use |
| Penicillin | 125 mg twice daily <5 years old 250 mg twice daily 5 years and older | Asplenia, terminal complement defects |
| Amoxicillin | 40 mg/kg/day divided twice daily; max dose 500 mg | Mild hypogammaglobulinemia as an alternative to IgRT |
| Fluconazole | 5–6 mg/kg/day; max 200 mg daily | Consider drug interactions Monitor transaminases Prophylaxis against yeast; no filamentous mold (e.g., Aspergillus) activity |
| Itraconazole | 5–10 mg/kg/day; max 100 mg (<50 kg) or 200 mg (>50 kg) | Consider drug interactions and monitoring drug levels Monitor transaminases |
| Posaconazole | 300 mg tablets daily for adults and children >40 kg 6 mg/kg/day of tablets for children <40 kg | Tablet dosing differs from suspension dosing Consider drug interactions Check trough level and transaminases 1–2 wk after initiation Check EKG for QTc |
| Acyclovir | 80 mg/kg/day divided twice daily or TID 400 mg twice daily adult dosing for HSV/Varicella/Zoster (VZV) suppression | Encourage hydration and monitor renal function Can use in patients with SCID if at risk for HSV Do not use if on valganciclovir Consider acyclovir or valacyclovir with JAK inhibition |
| Valacyclovir | 500–1,000 mg daily for adults 20 mg/kg/day divided twice daily to 500 mg twice daily max for pediatrics | Do not use if on valganciclovir Consider acyclovir or valacyclovir with JAK inhibition |
| Valganciclovir | 10–20 mg/kg daily, max 900 mg/day | Monitor for cytopenias and elevated transaminases For SCID with suspicion of CMV exposure or CMV disease |
| Antimicrobial . | Dosage . | Comments . |
|---|---|---|
| TMP/SMX | 5 mg/kg/day TMP component, divided twice daily; max dose 160 mg TMP 5 mg/kg TMP component divided twice daily 3 days/wk | Twice daily dosing for bacterial prophylaxis in CGD, HIES; consider for PADs 3 days/wk dosing for PJP prevention in SCID, athymia, CID at risk (e.g., Hyper IgM syndrome) Monitor for cytopenias; Folinic acid can minimize risk Consider atovaquone or pentamidine as alternatives for PJP prevention |
| Azithromycin | 5 mg/kg/day; max dose of 250 mg daily or 5 mg/kg/day or 500 mg 3 days/wk | Check EKG for QTc interval and consider hearing screen Monitor for resistance with long-term use |
| Penicillin | 125 mg twice daily <5 years old 250 mg twice daily 5 years and older | Asplenia, terminal complement defects |
| Amoxicillin | 40 mg/kg/day divided twice daily; max dose 500 mg | Mild hypogammaglobulinemia as an alternative to IgRT |
| Fluconazole | 5–6 mg/kg/day; max 200 mg daily | Consider drug interactions Monitor transaminases Prophylaxis against yeast; no filamentous mold (e.g., Aspergillus) activity |
| Itraconazole | 5–10 mg/kg/day; max 100 mg (<50 kg) or 200 mg (>50 kg) | Consider drug interactions and monitoring drug levels Monitor transaminases |
| Posaconazole | 300 mg tablets daily for adults and children >40 kg 6 mg/kg/day of tablets for children <40 kg | Tablet dosing differs from suspension dosing Consider drug interactions Check trough level and transaminases 1–2 wk after initiation Check EKG for QTc |
| Acyclovir | 80 mg/kg/day divided twice daily or TID 400 mg twice daily adult dosing for HSV/Varicella/Zoster (VZV) suppression | Encourage hydration and monitor renal function Can use in patients with SCID if at risk for HSV Do not use if on valganciclovir Consider acyclovir or valacyclovir with JAK inhibition |
| Valacyclovir | 500–1,000 mg daily for adults 20 mg/kg/day divided twice daily to 500 mg twice daily max for pediatrics | Do not use if on valganciclovir Consider acyclovir or valacyclovir with JAK inhibition |
| Valganciclovir | 10–20 mg/kg daily, max 900 mg/day | Monitor for cytopenias and elevated transaminases For SCID with suspicion of CMV exposure or CMV disease |