GLOSSARY AND GUIDELINES FOR USE

Preparations

Information contained herein refers to products and formulations currently stocked by the pharmacy department, RWH. Others preparations may be available. Please contact the pharmacy department for advice.

Age

Where reference is made to age, this refers to the day or week of life. Where corrected age has been used, this refers to corrected gestational age and is a marker of system development.

IV Drug Protocol

Where reference is made to IV drug protocols, these are available in the NICU and provide details on the preparation and administration of parenteral medications.

Extemporaneous preparations

Where (RWH) appears in relation to extemporaneous preparations, it refers to preparations compounded according to RWH pharmacy department formulations.

ABBREVATIONS

ACE angiotensin converting enzymeAV atrioventricularBP blood pressureBSL blood sugar levelBW birth weightCA corrected ageCAP capsuleCMV cytomegalovirusCNS central nervous systemCONS coagulase negative staphylococcus aureusCR controiled releaseCRE creamCW current weightEAR ear dropFBC full blood countg gramG10% glucose 10%G5% glucose 5%G6PD glucose 6 phosphate dehydrogenase deficiencyGA gestational ageGBS group B streptococcusGI gastrointestinalHIV human immunodeficiency virusHlry hearlyHSV herpes simplex virusIA intra arterialIC intra cardiacID infectious diseaseIM intra muscularINF infusionINH inhaler by inhalationINJ injectionIUGR intra uterine growth restrictionIV intra venouskg kilogram

ABBREVATIONS

LFT liver function testLOT lotionM,W,F Monday, Wednesday, Fridaymg milligrammins minutesMIXT mixturemL milli litreMRSA methicillin resistant staphylococcus aureusNaCl sodium chlorideNEB nebuleNEC necrotizing enterocolitisNICU neonatal intensive care unitNSAIDs non steroidal anti-inflammatory drugsOC eye ointmentPCP pneumocystis carinii pneumoniaPG1 primene/glucose solution (RWH)PG2 primene/glucose solution (RWH)PR per rectumPRN when requiredRCH royal children’s hospital MelbourneSACH sachetSAS special access schemeSC sub cutaneousSCN special care nurserySOL solutionSTAT immediatelySUSP suspensionTAB tabletTFT thyroid function testTOP topicalTSH thyroid stimulating hormoneUV umbilical veinWFI water for injection

CAFFEINE BASEXanthine Derivative

PreparationsINJ 10mg/mLMIXT 10mg/mL (RWH)

IV preparation and compatibilitiesCompatible with G5%, NaCl 0,9%. Give over 30 mins.

DoseNeonatal apnoeaLoading doseIV, ORAL : 10mg/kg/doseMaintenance dose (commence 24 hours after loading dose)IV, ORAL : 2,5mg/kg/dose 24hrly. May be increased to 5mg/kg/dose.Neonates CA >44 weeks may require doses up to 5mg/kg/dose 12hrly.

NotesPrescribe as caffeine bare.(2mg caffeine citrate = 1mg caffeine base)Caution in renal and liver impairment.Give oral doses with feeds. Signs of toxicity are gastric irritation, agitation, tachycardia and dieresis. Approx time to steady state is 5 to 6 days. Monitoring of levels is not required.

ACETAZOLAMIDECarbonic Anhydrase inhibitor

PreparationsTAB 250mgINJ 500mgIV preparation and compatibilitiesCompatible with G5%, NaCl 0,9%.Reconstitute 500mg vial with 5mL WFI to give a concentration of 100mg/mL.Give over at least 5mins.Preparation for other routesORAL : Take 1mL (100mg) of reconstituted IV solution and further dilute to 12,5mL with G5%. This gives an 8mg/mL solution. Prepare a fresh solution every 24 hours.DoseGlaucomaORAL : 5mg/kg/dose 6 to 8hrlyMetabolic AlkalosisIV : 7,5mg/kg/dose 8hrly.Renal Tubular AcidosisIV, ORAL : 5mg/kg/dose 8 to 12hrlyNotesMay colour faces black. May cause severe metabolic acidosis in sick premature infants. Monitor electrolytes and blood gases. Consider maintenance sodium bicarbonate during high dose therapy. Avoid extravasation.

ACICLOVIRAntiviral

PreparationsTAB 200mg, 800mgINJ 250mgOINT 5%OC 3%IV preparation and compatibilitiesCompatible with G5%, NaCl 0,9%.Reconstitute 250mg vial with 10mL WFI to give a concentration of 25mg/mL. Further dilute to 5mg/mL with NaCl 0.9%.Give over 1 hour via syringe pump.

Preparation for other routesORAL Dissolve 200mg tablet in 10mL WFI to give a concentration of 20mg/mL. Give required dose by oral syringe. Prepare a fresh solution for each dose.DoseUse only following discussion with neonatologist and/or in consultation with clinical microbiologist.Herpes Simplex and Varicella ZosterIV : 20mg/kg/doseIntervalCA <30 weeks 24hrlyCA 30 to 32 weeks 18hrlyCA > 32 weeks 12hrlyConsider reducing dose interval in babies over 1 week of age, if renal function adequate.OC : apply 1cm to the affected eye five times a day for 14 days.OINT : apply five times a day for 5 days.NotesMay need to increase dose interval in renal impairment and preterm infants. Observe urine output, particularly if given with other nephrotoxic drugs. Ensure adequate hydration.For HSV infection of skin, eye or mouth, treat for a minimum of 14 days.For disseminated or CNS disease, treat for 21 days.

ADENOSINEAnti-arrhythmic

PreparationsINJ 6mg/2mLIV preparation and compatibilitiesCompatible with NaCl 0,9%.Dilute to 1mg/mL solution with NaCl 0,9%.Give over 1 to 2 seconds. Follow with a rapid bolus of 2mL NaCl 0,9% to flush line.DoseSupraventricular TachycardiaIV : 0,05mg/kg/dose. Increase by 0,05mg/kg/dose every 2mins to a maximum of 0,25mg/kg/dose.

NotesContraindicated in second or third degree AV block or sick sinus syndrome.Flushing, dyspnoea, transient arrhythmias and bradycardia may occur. Monitor BP. Larger doses may be required in patients receiving theophylline or caffeine.

ADRENALINEAlpha beta adrenergic agent

PreparationsINJ 0,1mg/mL (1:10.000)INJ 1mg/mL (1:1000)IV preparation and compatibilitiesCompatible with G5%, G10%, NaCl 0,9%.IV ET use 1:10.000, no dilution required.IV INF use 1:1000 and prepare a per IV drug protocol.Preparation for other routesNEB use 1:1000. Dilute required dose to at least 2mL with NaCl 0,9%.DoseResuscitationUse 1:10.000IV, ET, IC, IM, SC : 0,1 to 1mL/kg/dose every 3 to 5mins as needed.HypotensionUse 1:1000IV, INF : 0,05 to 1mg/kg/doseNEB : 0,5mg/kg/dose 4 to 6hrly.NotesCorrect hypovolaemia and acidosis before commencing adrenaline infusion. May cause hypokalaemia. Do not mix with sodium bicarbonate.

ALPROSTADILProstaglandin E1

PreparationsINJ 500microgram/1mLIV preparation and compatibilitiesCompatible with G5%, NaCL 0,9%.Dilute according to IV drug protocol.

DoseTo open a closed ductus arteriosusIV : 100nanogram/kg/min for up to 30 minsTo maintain patency of ductus arteriosusIV INF : 10 to 20nanogram/kg/min.NotesMost effective for maintenance of ductus arteriosus if given in the first 96 hours after birth. Apnoea, hypotension, flushing, fever and bradycardia may occur. Be prepared to intubate and ventilate. Monitor BP.Contraindicated in respiratory distress syndrome and total anomalous pulmonary venous drainage with obstruction.Use with caution in patient with bleeding tendencies and seizure disorder.

AMIKACINAminoglycoside antibiotic

PreparationsINJ 500mg/2mLIV preparation and compatibilitiesCompatible with G5%, G10%, NaCl 0,9 %.Dilute 125mg (0,5mL) to 50mL with NaCl 0,9% to give a concentration of 2,5mg/mL.DoseUse only following discussion with neurologist and/or in consultation with clinical microbiologist.IV : 7,5mg/kg/doseIntervalCA <28 weeks 36hrlyCA 28 to 29 weeks 24hrlyCA 30 to 35 weeks 18hrlyCA >36 weeks 12hrlyFor babies CA >37 weeks and >7 days of age, give 8hrly.NotesTherapeutic levels :Peak 20 to 30mg/LTrough < 10mg/LTake levels on 2nd dose for 36 and 48hrly doses, and 3rd dose for other dose frequencies. Take trough level immediately before dose. Take peak level 30mins

after infusion is finished. Adjust dose in renal impairment. The risk of nephrotoxicity and ototoxicity is increased when used in combination with vancomycin, frusemide and/or other aminoglycoside antibiotics.

AMINOPHYLLINEXanthine derivative

PreparationsINJ 250mg/10mLIV preparation and compatibilitiesCompatible with G5%, NaCl 0,9%.Dilute to 5mg/mL with NaCl 0,9% and give over at least 20mins.DoseNeonatal apnoeaLoading dose IV : 6mg/kg/doseMaintenance doseCommence< 1kg 24hrs after loading> 1kg 12hrs after loadingIVAge < 7 days 2,5mg/kg/dose 12hrlyAge 8 to 14 days 3mg/kg/dose 12hrlyAge > 14 days 4mg/kg/dose 12hrlyNotesHigh levels may cause tachycardia therefore monitor heart rate prior to administering dose. Therapeutic range 40 to 80micromol/L. levels not routinely taken but if toxicity suspected take sample just prior to next dose. Many drug interactions.Consider monitoring levels if given with erythromycin, ciprofloxacin, phenobarbitone, phenytoin or frusemide.

AMIODARONEAnti-arrhythmic

PreparationsTAB 100mg, 200mgINJ 150mg/3mL

IV preparation and compatibilitiesCompatible with G5%.Add 10mg (0,2mL) to 4,8mL G5% to give concentration of 10mg/5mL.Give dose slowly over 1 hour via syringe pump.INF dilute according to IV drug protocol.Use diluted solutions within 12 hours.DoseUse only following discussion with pediatric cardiologistSupraventricular and ventricular tachyarrhythmiasORAL : 4mg/kg/dose 8hrly for 1 week, then 12hrly for 1 week, then daily there 2 afterIV INF : 25microgram/kg/min for 4 hours, then give 5 to 15microgram/kg/min, titrated according to response.NotesMonitor for hypotension and ensure continuous ECG monitoring during IV therapy. Monitor LFTs and TFTs according to cardiologist.Use with caution in hypotensive state.Reduce digoxin dose 50% if used concurrently. Photosensitivity may occur, babies need to use sunscreen and protective clothing if exposed to sunlight..Amiodarone leaches plasticizer (DEHP) from PVC containing infusion bags, which may affect male reproductive tract development. Use non-DEHP lines and either Terumo® or BD® syringe. Transfer to oral therapy as soon as possible to minimize exposure.Injection contains benzyl alcohol.

AMOXYCILLINPenicillin antibiotic

PreparationsMIXT 125mg/5mL, 250mg/5mLINJ 500mg, 1gIV preparation and compatibilitiesCompatible with G5%, NaCl 0,9%.Reconstitute 500mg vial with 4,6mL WFI to give a concentration of 100mg/mL.Give over at least 10mins.Preparation for other routesIM reconstitute 500mg with 2,6mL WFI to give a concentration of 500mg/3mL.Do not give more than 500mg per IM injection. Consult senior neonatologist prior to presc..oing by IM route.

ORAL : reconstitute powder with WFI according to package insert. Store in refrigerator.DoseStandard infectionIV, IM : 25mg/kg/doseSevere infection (meningitis, septicaemia)IV, IM : 50mg/kg/doseIntervalCA < 37 < 28 days 12hrly

> 28 days 8hrlyCA > 37 < 7 days 12hrly

> 7 days 8hrlyDosage interval may be decreased from 8 to 6hrly in suspected meningitis or septicemia.ORAL : 7,5 to 25mg/kg/dose 8hrlyNotesCaution in renal impairment, extend dose interval if necessary.Contraindicated in patients with a history of penicillin allergy.

AMOXYCILLIN/CLAVULANIC ACIDPenicillin anti-biotic/Beta lactamase inhibitor

PreparationsMIXT 400mg/57mg in 5mL(Augmentin Duo®)Preparation for other routesORAL : reconstitute powder with WFI according to package insert. Store in refrigerator.DoseDoses refer in amoxicillin content on Duo productORAL : 12,5 to 22,5mg/kg/dose 12hrlyNotesContraindicated in patients with a history of penicillin allergy.Best given just before a feed.

AMPHOTERICIN B (CONVENTIONAL)Anti-fungal

PreparationsINJ 500mgPharmacy will prepare preloaded syringe Monday to Friday.IV preparation and compatibilitiesCompatible with G5%.Reconstitute 50mg vial with 10mL WFI to give concentration of 5mg/mL. Withdraw 1mL of resulting solution and dilute to 50mL with G5% to give concentration of 0,1mg/mL. Withdraw dose and give over 6 hours via syringe pump.Do not infuse through PALL® filter.DoseConsider using conventional preparation in babiesCA > 30 weeks or BW > 2500g.IV : 0,25mg/kg/dose 24hrly.Increase by 0,25mg/kg/dose 24hrly to a maximum of 1mg/kg/dose.Dose increment can be increased by 0,5mg/kg/day in severe infection, if renal function is adequate and infusion is tolerated.NotesCaution in renal impairment.Many adverse effect including hypokalaemia and nephrotoxicity.Monitor renal function, electrolytes and FBC.Concurrent administration of other nephrotoxic drugs (aminoglycosides, vancomycin) may increase risk of nephrotoxicity.Digoxin toxicity may occur secondary to hypokalaemia caused by amphotericin B

AMPHOTERICIN B (LIPOSOMAL)Anti-fungal

PreparationsINJ 50mgPharmacy will prepare preloaded syringes Monday to Friday.IV preparation and compatibilitiesCompatible with G5%.Reconstitute 50mg vial with 12mL WFI to give a concentration of 4mg/mL.Further dilute with G5% according to IV drug protocol and give over 1 hour.Use only G5% for dilution. Do not infuse through PALL® filter.

DoseUse only following discussion with neonatologist and/or in consultation with clinical microbiologist.Liposomal preparation should always be used for babiesCA < 30 weeks or BW < 1250gIV : 1mg/kg/dose 24hrly increasing by 1mg/kg/dose in a maximum of 3mg/kg/dose 24hrly.Doses of 5mg/kg/dose 24hrly have been used and may be considered if renal function is adequate.NotesAlthough adverse effects are reported less frequent than with conventional treatment, the same precautions apply for liposomal amphotericin.Caution in renal impairment.Many adverse effect including hypokalaemia and nephrotoxicity.Monitor renal function, electrolytes and FBC. Concurrent administration of other nephrotoxic drugs (aminoglycoside, vancomycin) may increase risk of nephrotoxicity.Digoxin toxicity may occur secondary to hypokalaemia caused by amphotericin B.

ATROPINEAnti-cholinergic/mydriatic

PreparationsINJ 400mcg/mLEYE 1%IV preparation and compatibilitiesCompatible with G5%, NaCl 0,9%.Dilute 100microgram (0,25mL) to 1mL with NaCl 0,9% to give a concentration of 100microgram/mL. Give over 1 minute.DoseET intubation, resuscitationIV, ET : 20microgram/kg/dose. Repeat at 5 to 10 minute intervals as needed.MydriasisEYE : instill one drop 8hrly for three days prior to surgeryApply pressure (where possible) to lacrimal sac for 1 to 2mns following application to reduce systemic absorption.

NotesFor ET intubation give prior to soxamethonium. Peak increase in heart rate occurs in 2 to 4mins.

BENZYLPENICILLINPenicillin anti-biotic

PreparationsINJ 600mg(equivalent to 1.000.000units)IV preparation and compatibilitiesCompatible with G5%, NaCl 0,9%.Reconstitute 600mg with 5,6mL WFI to give concentration of 100mg/mL and give dose slowly over at least 5mins.Preparation for other routesIM reconstitute 600mg with 1,6mL WFI to give a concentration of 300mg/mLDoseStandard infectionIV, IM : 60mg/kg/doseCBS meningitisIV, IM : 120mg/kg/doseIntervalsCA < 17 weeks 12hrlyCA > 17 weeks < 7 days 12hrly

> 7 days 8hrlyNotesContraindicated in patients with a history of penicillin allergy.IV preparation contains 1,7mmol of sodium per 600mg.

CAFFEINE CITRATEXanthine derivative

PreparationsINJ 20mg/mL caffeine citrate.20mg caffeine citrate = 10mg caffeine baseIV preparation and compatibilitiesCompatible with G5%Give slowly over 30mins.

DoseDoses expressed as caffeine citrate.Neonatal apnoeaLoading doseIV, ORAL : 20mg/kgMaintenance dose(commence 24hrs after loading dose)IV, ORAL : 5mg/kg/dailyMaintenance dose can be increased to a maximum or 10mg/kg/dayNotesCaution in renal and liver impairment.Give oral doses with feeds.Sign of toxicity are gastric irritation, agitation, tachycardia and dieresis. Approx time to steady state is 5 to 6 days. Monitoring of levels is not required.

CALCITRIOLActive form of vitamin D3

PreparationsCAP 0,25microgramMIXT : SAS 1microgram/mLDoseUse only following consultation with renal physician or endocrinologist.Hypocalcaemia, hypoparathyroidism, renal failureORAL : 0,02microgram/kg/day.NotesLiquid inside capsule 0,17mL = 0,25microgram (1,5microgram/mL).Monitor serum alkaline phosphate, calcium, phosphate and creatinine.Content of capsule may be removed by carefully piercing the capsule at each end and pushing air through capsule to force liquid out the opposite hole onto a spoon. Ensure operator safety at all times.

CALCIUMSupplemen

PreparationsINJ Calcium gluconate 10%(100mg/mL = 0,22mmol calcium/mL)TAB 1000mg SandoCal® (25mmol)

IV preparation and compatibilitiesCompatible with G5%, G10%, NaCl 0,9%.Dilute bolus and correction doses to 20mg/mL (1 in 5) i.e 1mL to 5mL.Give slowly over 30 to 60mins or by infusion.Preparation for other routesORAL Dissolve one SandoCal® tablet in 45ml WFI to give a concentration of 50mg in 2,5mL (1mmol Ca2 + in 2mL).Prepare a fresh solution for each dose.DoseSymptomatic hypocalcaemia-acute treatmentIV bolus : 0,11mmol/kg (0,5mL/kg of 10% solution) over 20 to 60mins.IV correction : 0,44mmol/kg (2.0mL/kg of 10% solution) over 6 hours.Hypocalcaemia maintenanceIV INF : 1mmol/kg/day (4,5mL/kg/day of 10% solution)ORAL : 50mg/dose 4 to 6 times a dayNotesMonitor for bradycardia and arrhytmias. Avoid extravasation.Give oral supplements between meals.

CAPTOPRILACE inhibitor

PreparationsTAB 25mgMIXT 1mg/mL (RWH)Preparation for other routesDissolve a 25mg tablet in 25mL WFI to give a concentration of 1mg/mL. Refrigerate after preparation. Prepare a fresh solution every 24 hours.DoseTest doseORAL : 0,01mg/kgIf tolerated, increase slowly, according to response.MaintenanceORAL : 0,01 to 0,05mg/kg/dose 8hrlyIncrease if necessary to a maximum of 0,5mg/kg/doseReduce dose in renal impairment.NotesUse with caution.

BP monitoring is essential. Monitor BP prior to dosing and every 30mins for the first 2 hours after administration. Then reduce monitoring to every 4 hours. Follow this regimen for each dose until a stable maintenance dose is reached. Then monitor BP every 4 hours.Use with extreme caution in hyponatraemia and monitor serum sodium during therapy. Correct hyponatraemia prior to initiating therapy. Strongly consider stopping spironolactone. Monitoring potassium level and renal function. Maintain adequate hydration. Administer on an empty stomach.

CARBAMAZEPINEAnti-convulsant

PreparationsTAB 100mg, 200mg, 200mg CR, 400mg CRMIXT 20mg/mLPreparation for other routesIt is possible to give the suspension rectally to temporally replace oral therapy. Give some total daily dose in small multiple doses. Dilute 1:1 with warm water. May have laxative effect.DoseExperience is limited in neonates.ORAL : commence at 2,5mg/kg/dose 12 hrlyIncreasing every 2 days to maximum of 15mg/kg/dose 12 hrlyNotesCR tablets can be halved but not crushed. Suspension to be given alone. Avoid use in active liver disease. Increase dose slowly to allow for enzyme induction upon initiation of therapy.Serum levels: Range : 20-40micromol/L.Sample immediately before next dose. Time to steady state approx 1 to 2 weeks.

CARBIMAZOLEAnti-thyroid agent

PreparationsTAB 5mgMIXT 1mg/mL (RWH)DoseUse only after discussion with pediatric endocrinologist.ORAL : 0,2mg/kg/dose 8hrly for 2 to 3 weeks then reduce to 0,1mg/kg/dose 8 to 24hrly, adjusted according to thyroid function test.

NotesCan combine with thyroxine replacement therapy(useful if goiter size is a problem).

CEFOTAXIME3rd Generation cephalosporin

PreparationsINJ 1g, 2gIV preparation and compatibilitiesCompatible with G5%, G10%, NaCl 0,9%.Reconstitute 1g with 9,6mL WFI to give a concentration of 100mg/mL. May be diluted to 50mg/mL. Give over at least 10mins.Preparation for other routesIM reconstitute 1g with 3,6mL WFI to give a concentration of 250mg/mL.DoseIV, IM : 50mg/kg/doseIntervalCA < 30 weeks < 28 days 12hrly

> 28 days 8hrlyCA > 30 weeks < 14 days 12hrly

> 14 days 8hrlyDose interval may be reduced from 8hrly to 6hrly in severe ingections/meningitis.NotesMay require dosage interval to be increased in babies with severe renal failure.

CEFTAZIDIME3rd Generation cephalosporin

PreparationsINJ 1g, 2g.IV preparation and compatibilitiesCompatible with G5%, G10%, NaCl 0,9%.Reconstitute with WFI (1g with 8,9mL, 2g with 18,2mL) to give a concentration of 100mg/mL. May be diluted to 50mg/mL. Give over at least 10mins.Preparation for other routesIM reconstitute 1g vial with 2,9mL WFI to give a concentration of 250mg/mL(total volume 4mL).

DoseUse only following discussion with neonatologist and/or in consultation with clinical microbiologist.IV : 50mg/kg/doseIntervalCA < 30 weeks < 28 days 12hrly

> 28 days 8hrlyCA > 30 weeks < 14 days 12hrly

> 14 days 8hrlyNotesMay require dosage interval to be increased in babies with severe renal failure.Used for infections caused by susceptible organisms with suspected or documented resistance to other antibiotics in consultation with microbiology.

CEFTRIAXONE3rd Generation cephalosporin

PreparationsINJ 1g, 2gIV preparation and compatibilitiesCompatible with G5%, G10%, NaCl 0,9%.Reconstitute 1g vial with 9,6mL WFI to give a concentration of 100mg/mL.DoseStandard infectionIV : 50mg/kg/dose 24hrlySevere infection (meningitis)IV : 100mg/kg/dose 24hrly or 50mg/kg/dose 12hrlyNotesDisplaces bilirubin from serum albumin. Not recommended in neonates with unconjugated hyperbilirubinaemia.IM route may be used only where no IV acces is available and after discussion with senior neonatologist.

CHLORAL HYDRATESedative/hypnotic

PreparationsMIXT 100mg/mL

DoseSedativeORAL : 8mg/kg/dose 6 to 8hrlyHypnoticORAL : 25 to 50mg/kg/dose 24hrly (maximum 1g per dose)In ventilated patients, higher dose up to 50mg/kg/dose 6hrly may be used if required.NotesMay cause nausea, vomiting and diarrhea. Dose may be diluted with water or feed to reduce these side effect. Tolerance may develop after long term therapy.

CHLORAMPHENICOLAntibiotics

PreparationsEYE/EAR 0,5%OC 1%DoseOC : apply 0,5 to 1,5cm up to 3hrly or at night if drops are being used during the day.EYE : instill 1 drop, 2 to 6hrly for 2 to 3 days after clinical symptoms have resolved, and then decrease to 3 to 4 times a day.EAR : instill 4 drops 6hrly.NotesTreat both eyes.Discard all topical products 30 days after opening.

CIPROFLOXACINQuinolone antibiotic

PreparationsTAB 500mgINJ 2mg/mLIV preparation and compatibilitiesCompatible with G5%, G10%, NaCl 0,9%.DoseUse only following discussion with neonatologist and/or in consultation with clinical microbiologist.

Standard infectionIV, ORAL : 5mg/kg/dose 12hrlySevere infectionIV, ORAL : 10 to 15mg/kg/dose 12hrlyNotesControversy east over the possibility of ciprofloxacin causing arthropathy in children. Monitor theophyline levels on day 3 of ciprofloxacin treatment. Decrease levels by 50% is elevated.

CLINDAMYCINAntibiotics

PreparationsINJ 150mg/mLCAP 150mgIV preparation and compatibilitiesCompatible with G5%, NaCl 0,9%.Dilute to a maximum concentration of 12mg/mL.Give over at least 30mins.DoseUse only following discussion with neonatologist and/or in consultation with clinical microbiologist.Age < 7 days :BW < 2000g 5mg/kg/dose 12hrlyBW> 2000g 7,5mg/kg/dose 12hrlyAge > 7 days :CW < 1200g 5mg/kg/dose 12hrlyCW 1200-2000g 5mg/kg/dose 8hrlyCW > 2000g 5mg/kg/dose 6 to 8 hrlyNotesRisk of hypotension and cardiopulmonary arrest if given quickly. Discontinue if severe diarrhea develops and investigate cause. Increase dosage interval in patients with significant liver dysfunction.

CLONAZEPAMBenzodiazepine/anticonvulsant

PreparationsINJ 1mg/mLMIXT 2,5mg/mL (1 drop = 0,1mg), 100microgram/mL (RWH)IV preparation and compatibilitiesCompatible with G5%, G10%, NaCl 0,9%.Dilute with diluents provided immediately before use to give a concentration of 1mg in 2mL. Give over 5mins.Preparation for other routesWhen giving mixture, count droop onto a spoon before administering. Do not give directly from bottle to patients as overdosing may occur easily.DoseLoading doseIV, ORAL : 0,1 to 0,25mgUse lower doses for premature infants. If fitting persist, subsequent doses may be given.Maintenance doseIV, ORAL : 0,01mg/kg/dose 8hrlyCommence maintenance dose 8 hours after loading dose. Maintenance dose may be increased every 3rd day to a maximum of 0,4mg/kg/day.NotesDoses should be reduced gradually when treatment is to be ceased to reduce the risk of withdrawal symptoms. Rapid IV injection may cause respiratory depression. Possible elevation of phenytoin levels, CNS depression, hypotension, upper airway hypersecretion and increased salivation may occur. Therapeutic range 60 to 150nanomol/L.

CLOTRIMAZOLEAntifungal

PreparationsCRE 1%DoseTOP : apply to affected area 2 to 3 times a day and for at least 7 days after clinical symptom have insolved.

COPPERSupplement

PreparationsMIXT 20microgram/mL (RWH)DoseORAL : 25microgram/kg/dayNotesMixture prepared by pharmacy department.

CO-TRIMOXAZOLE (TRIMITHOPRIM AND SULFAMETHOXAZOLE)Dihydrofolate reductase inhibitor/sulfonamide

PreparationsMIXT 8/4Cmg/mLDoseDose expressed as content of trimethoprim.Standard infectionTreatmentORAL : 4mg/kg/dose 12hrlyProphylaxisORAL : 2mg/kg/dose at nightPneumocystis carinii pneumonia (PCP)Use only following discussion with neonatologist and/or clinical microbiologist.TreatmentIV, ORAL : 5mg/kg/dose 6hrly (max 320mg/dose).ProphylaxisORAL : 5mg/kg/dose (max 160mg/dose) once daily on 3 days/week (M, W, F).NotesDo not use in jaundiced neonates.Not recommended before week 4 of life due to risk of kernicterus. Best given with food. Monitor folate status of patient if treatment is long term or high dose. Contraindicated in G6PD deficiency. Can cause photosensitivity.

DEXAMETHASONECorticosteroid

PreparationsINJ 5mg/mLMIXT 0,5mg/mL (RWH)IV preparation and compatibilitiesCompatible with G5%, G10%, NaCl 0,9%.Dilute to 1mg/mL and give required dose over 1minute.DoseChronic lung disease/bronchopulmonary dysplasiaDART RegimenIV, ORAL :Day 1,2,30,075mg/kg/dose 12hrly for 6 dosesDay 4,5,60,05mg/kg/dose 12hrly for 6 dosesDay 7,80,025mg/kg/dose 12hrly for 4 dosesDay 9,100,01mg/kg/dose 12hrly for 4 dosesCourse may be repeated once if necessary.Cummings regimenIV, ORAL :Day 1,2,30,25mg/kg/dose 12hrly for 6 dosesDay 4,5,60,15mg/kg/dose 12hrly for 6 dosesDay 7 and afterDecrease dose by 10% every 3 days until dose of 0,1mg/kg/day is reached. Then give on alternate days for 1 week, then cease. If initially ineffective discontinue after 5 days.To prevent failure of ET extubation and post extubation stridor.IV, ORAL : 0,25mg/kg/dose 8hrly for 3 doses. Give last dose 1 hour prior to extubation.

NotesHypertension and hyperglycemia may occur.Monitor BP and blood glucose. Ensure all existing infection are treated before commencing dexamethasone. Oral antifungal medication (Nystatin) to commence on day 1 of treatment and continue for three days after dexamethasone has ceased.

DIAZOXIDEAntihypertensive

Anti-hypoglycemic agentPreparationsINJ 15mg/mLCAP (SAS) 100mgMIXT (SAS) 10mg/mL (RWH)IV preparation and compatibilitiesOral route preferred. Only use IV if oral therapy contraindicated. Contact pharmacy for further advice.DoseUse only after discussion with pediatric endocrinologist.Hypoglycemia secondary to hyperinsulinemiaORAL : 2 to 5mg/kg/dose 8hrly as recommended by endocrinologist. May be increased to maximum of 15mg/kg/day.NotesMonitor blood pressure 30mins after dose.Monitor patients for arrhythmias and hyperglycemia.Blood descarias may occur with prolonged use. May have anti-diuretic effect. May cause hirsutism.

DIGOXINCardiac glycoside

PreparationsINJ 25microgram/mLTAB 62,5microgram, 250microgramMIXT 50microgram/mLIV preparation and compatibilitiesCompatible with G5%, NaCl 0,9%.

Dilute to 5microgram/mL. Withdraw required dose and give slowly over 5 to 10mins.DoseUse only after discussion with pediatric cardiologist.Loading dose (total 3 doses) for arrhytmias onlyCA < 37 weeksIV, ORAL : 10microgram/kg/dose then 5 microgram/kg/dose 8hrly for 2 doses.CA > 37 weeksIV, ORAL : 10microgram/kg/dose 8hrly for 2 further dosesMaintenance doseIV, ORAL : 3 to 5microgram/kg/dose 12hrlyNotesReduce dose in renal impairment.Consider lower dose in patients being treated with indomethacin or …. Halve dose a given with amodalone.Hypokalaemia may increase risk of digoxin toxicity (with or without increased digoxin levels) therefore drugs which cause hypokalaemia may predispose patients to digoxin tocixity.Therapeutic range 1 to 2,5nanomol/L. Serum level should be taken on 3rd day but more frequent level may be necessary.Take sample at least 6 hours after dose signs of toxicity include vomiting, diarrhea, drowsiness, bradycardia and arrhythmias. Doses must always be prepared in micrograms.

DOBUTAMINECardiac inotrope

PreparationsINJ 12,5mg/mLIV preparation and compatibilities Compatible with G5%, NaCl 0,9%.Dilute according to IV drug protocol and give as a continuous infusion via infusion pump. Do not mix strongly alkaline solutions or sodium bicarbonate.DoseImprovement of cardiac output and BPIV, INF : 5 to 20microgram/kg/minuteStart at 5microgram/kg/minute and increase after 10mins as needed.NotesUse with caution if given through peripheral line due to vasoconstriction action.

Correct hypovolaemia before commencing infusion. Observe IV site for imflammation, extravasation and extreme vasoconstriction (tracking).May be used together with dopamine.May cause tachycardia.Contraindicated in idiopathic hypertropic subaortic stenosis.

DOPAMINECardiac inotrope

PreparationsINJ 40mg/mLIV preparation and compatibilitiesCompatible with G5%, NaCl 0,9%.Dilute according to IV drug protocol and give as a continuous infusion via infusion pump.Do not mix with strongly alkaline solutions or sodium bicarbonate.DoseImprovement of cardiac output and BPIV, INF : 2 to 20microgram/kg/minNotesUse with caution if given through peripheral line due to vasoconstriction action.Correct hypovolaemia before commencing infusion. Observe IV site for imflammation, extravasation and extreme vasoconstriction (tracking).May be used together with dobutamine.Phenytoin given together with dopamine may cause severe hypotension.

ENOXAPARINLow molecular weight heparin

PreparationsINJ 20mg/0,2mL, 40mg/0,4mL, 80mg/0,8mL100mg/1mLPreparation for other routesCompatible with NaCl 0,9%.Dilute to 20mg/mL with NaCl 0,9%. Withdraw required dose and administer by sub cutaneous injection.

DoseFor use only after discussion with pediatric haematologist.Systemic anticoagulationTreatmentSC : 1,5mg/kg/dose 12hrlyProphylaxisSC : 0,75mg/kg/dose 12hrlyNotesExperience in neonates is limited. Dose reduction may be required in renal impairment. Monitor platelet count in the last week of therapy. For systemic anticoagulation … dose to achieve anti Na levels 4 hours post dose atTreatment : 0,5 to 1unit/mLProphylaxis : 0,2 to 0,4unit/mLFrequency at monitoring depends on the clinical situation. Usually monitor after 3rd dose and then weekly once stable.

ERYTHROMYCINMacrolide antibiotic

PreparationsINJ 300mg, 1gMIXT 200mg/5mL, 100mg/mLIV preparation and compatibilitiesCompatible with NaCl 09%.Reconstitute 300mg vial with 6mL WFI to give a concentration of 50mg/mL.Further dilute to 5mg/mL or less and give required dose over 60 to 120mins.Preparation for other routesORAL reconstitute powder with WFI according to package insert. Store in refrigerator.DoseStandard infectionIV, ORAL : 10mg/kg/dose 8hrlySevere infectionIV, ORAL : 15 to 25mg/kg/dose 8hrlyNotesErythromycin may lead to increase risk of hypertropic pyloric stenosis in the first 2 weeks of life.

Not recommended by IM injection due to pain at injection site. IV must be administered over at least 1 hour due the risk of extravasation and pain at injection site. May increase theophylline and digoxin levels.

ERYTHROPOIETINErythropoietic hormone

PreparationsINJ 1000units/mLIV preparation and compatibilitiesCompatible with NaCl 0,9%.Decant required dose from pre filled syringe into appropriately sized syringe.DoseIV, SC : 200 to 400units/kg/dose, every second day for 10 doses.NotesSubcutaneous dosing is more effective than IV.Adequate iron store are necessary for an appropriate response to erythropoietin. Consider iron supplementation.Clearance in neonates is 3 to 4 times that of adults.

FENTANYLOpioid analgesic

PreparationsINJ 50microgram/mLIV preparation and compatibilitiesCompatible with G5%, NaCl 0,9%.Dilute with WFI to give a concentration of 10microgram/mL and give prescribed dose over 10mins.INF dilute and administer according to IV drug protocol.DoseAnalgesia in ventilated patients onlyIV : 1 to 5microgram/kg/dose 2 to 3hrly as required.IV, INF : 1 to 5microgram/kg/hourNaloxone (0,1mg/kg/dose) must be available for reversal.NotesUse only in ventilated patients. … respiratory depressant. Monitor chest wall rigidity. Monitor patient carefully as clearance is highly variable.Tolerance may be develop following constant infusion.

Significant withdrawal symptoms have been reported in patients treated with continuous infusion longer than 5 days.Duration of action 30 to 60mins, therefore analgesia effect is brief unless given by continuous infusion.

FLUCLOXACILLINBeta lactamase resistant

Penicillin antibioticPreparationsINJ 500mg, 1gMIXT 125mg/5mL, 250mg/5mLIV preparation and compatibilitiesCompatible with G5%, NaCl 0,9%.Reconstitute 500mg vial with 4,6mL WFI to give concentration of 100mg/mL. Take 1mL of this solution and further dilute to 2mL with WFI to give a concentration of 50mg/mL.Withdraw required dose and give over at least 10mins.Preparation for other routesIM reconstitute 500mg vial with 1,6mL WFI to give a concentration of 250mg/mLORAL reconstitute powder with WFI according to package insert. Store in refrigerator.DoseStandard infectionIV, IM, ORAL : 25mg/kg/doseSevere infectionIV, IM, ORAL : 50mg/kg/doseIntervalAge < 7 days 12hrlyAge 8 to 28 days 8hrlyAge > 28 days 6hrlyNotesCaution in patients with hepatic impairment. Oral doses best given on an empty stomach.Contraindicated in patients with a history of penicillin allergy.

FLUCONAZOLEAntifungal

PreparationsINJ 2mg/mLMIXT 10mg/mLIV preparation and compatibilitiesAdminister undiluted over at least 60mins.DoseUse only following discussion with neonatologist and/or in consultation with clinical microbiologist.Systemic infection and/or meningitisLoading doseIV, ORAL : 12mg/kg/doseMaintenance doseIV, ORAL : 6mg/kg/doseCutaneous infections, candidiasisLoading doseIV, ORAL : 6mg/kg/doseMaintenance doseIV, ORAL : 3mg/kg/doseIntervalAge < 14 days 72hrlyAge 15 to 28 days 48hrlyAge > 28 days 24hrlyNotesMonitor liver function test and discontinue if liver disease develops. Consider dose reduction in renal impairment. Do not use to treat C.krusei or C….May increase levels of phenytoin, theophylline and caffeine. Consider monitoring levels.IV preparation contains 15mmol sodium per 100mL.

FLUCYTOSINEAntifungal

PreparationsINJ 10mg/mLIV preparation and compatibilitiesAdminister undiluted.Give 10mg/mL over at least 30mins.Store between 150 and 250C in original container as precipitation occurs at prolonged storage under 150C and conversion to 5-fluorouracil occurs if stored above 250C.Flucytosine should be considered a potensial carcinogen in humans and must be handled as a cytotoxic drug.The pharmacy department will supply preloaded doses as 10mg/mL solutions Monday to Friday.DoseUse with following discussion with neonatologist and/or in consultation with clinical microbiologist.Use in combination with amphotericin B for systemic fungal infections not responding to conventional antifungal therapyStandard infectionIV : 25mg/kg/dose 6hrlySevere infectionIV : 50mg/kg/dose 6hrlyNotesDo not use alone. Monitor levels to avoid marrow toxicity. Measure peak 1hr after start of infusion and through immediately prior to next dose.Therapeutic dosePeak : 60 to 80mg/LTrough : 25 to 40mg/LToxic : > 100mg/LExercise caution in renal impairment and when used in combination with other drugs. Monitor liver function test.Infusion solution contain 34,4mmol of sodium per 250mL.

FOLIC ACIDSupplement

PreparationsINJ 15mg/mLTAB 0,5mg, 5mgIV preparation and compatibilitiesCompatible with G5%, G10%, NaCl 0,9%.Administer over minimum of 1 minute.DoseDeficiencyIV, ORAL : 50microgram once dailyNotesCan be given IM or SC if necessary.

FOLINIC ACIDCalcium leocovorin/calcium folinat

PreparationsINJ 50mg/5mL, 15mg/5mLTAB 15mgMIXT 10mg/mLIV preparation and compatibilitiesCompatible with G5%, NaCl 0,9%.DoseIn combination with pyrimethamine for toxoplasmosisORAL : 10mg three times a week (M, W, F)Biosmine neurotransmitter defectsORAL : 7,5mg once dailyNotesAntidote to folic acid antagonist. Used in combination for toxoplasmosis therapy.

FRUSEMIDELoop diuretic

PreparationsINJ 10mg/mLTAB 40mgMIXT 10mg/mL

IV preparation and compatibilitiesCompatible with NaCl 0,9%.Drug may precipitate at low pH. Administer no faster than 0,05mg/kg/min.DoseIV, ORAL : 0,5 to 2mg/kg/doseIntervalCA < 37 weeks 24hrlyCA > 37 weeks < 7 days 24hrly

> 7 days 12hrlyIV, INF : 0,1 to 1mg/kg/hourHigh dose therapy may be necessary in patients with renal impairment. Anuric/oliguric renal failure may require doses of 3mg/kg/dose or higher to establish urine output.Oral doses can be increased up to 6mg/kg/dose in resistant cases.NotesHypokalaemia, hypovolaemia and hypertension may occur.Risk of ototoxicity is increased with renal impairment, high dose, rapid IV administration and the use of other ototoxic drugs. Indomethacin may reduce diuretic response. If used long-term, monitor potassium and consider potassium supplement or the addition of potassium sparing diuretics.

GANCICLOVIRAntiviral

PreparationsINJ 500mgIV preparation and compatibilitiesCompatible with G5%, NaCl 09,%.Ganciclovir should be consider a potential carcinogen in humans and must be handled as a cytotoxic drug.The pharmacy department will supply preloaded doses as 5mg/mL solutions Monday to Friday.Infuse via syringe pump over 1hr.DoseUse only following discussion with neonatologist and/or in consultation with clinical microbiologist.Treatment of life threatening CMV diseaseIV : 5mg/kg/dose 12hrly

NotesNeutropenia and thrombocytopenia may occur requiring dose reduction. White blood cell and plateled counts should be taken every 2 days for the first 14 days.Do not use in combination with ……. Cilastatin.

GAVISCONAlginate

PreparationsSACH Gaviscon infant® (sodium alginate 225mg and magnesium alginate 87,5mg)Preparation for other routesCompatible with WFI, non-soy based feeds.Add contents of one Gaviscon infant® sachet to 10mL WFI. Shake well until powder disperse evenly. Gaviscon solution alone may be refrigerated for up to 12 hours.DoseRefer to guidelines for exact volumes of Gaviscon solution to be given per exact volumes of feed.For infant < 4,5kgFull strength :1 sachet per 120mL of feed.Half strength :½ sachet per 120mL of feedQuarter strength :¼ sachet per 120mL of feedConsult pharmacy for doses for infants over 4,5kg.NotesMix dose with feed immediately before giving dose.Do not use for soy-based formula feeds.

GENTAMICINAminoglycoside antibiotic

PreparationsINJ 10mg/mL, 40mg/mLEYE 0,3%.

IV preparation and compatibilitiesCompatible with G5%, G10%, NaCl 0,9%.For reconstitution and dilution refer to IV drug protocol.Give slowly over at least 30mins.DoseIV, IM : 5mg/kkg/doseIntervalBW < 1200gAge < 7 days 48hrlyAge 8 to 30 days 26hrlyAge > 30 days 24hrlyBW > 1200gAge < 7 days 36hrlyAge > 7 days 24hrlyNotesExtend dosage interval in patients with renal impairment. Risk of nephrotoxicity may increase if used together with other potentially nephrotoxic drugs such as indomethacin, vancomycin and amphotericin. Action of pancuronium may be potentiated by gentamicin.Take levels on 2nd dose for 36 and 48hrly doses.And on 3rd dose for 24hrly doses.Therapeutic levels :Trough : < 2mg/LPeak : 5 to 10mg/LTrough level is taken immediately before dose.Peak is taken 30mins after end of infusion.