Adult Dose. Adults Day 1: 1mg/kg daily Day 2: 2mg/kg daily Day 3 onwards: 3mg/kg daily. Where appropriate consider rounding dose to nearest 50mg.

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1 AMIKACIN All ages>1month: 30mg/kg daily 1.5g once daily IV infusion over Monitor renal function before treatment and weekly. Caution if used with other nephrotoxic drugs. Levels required. Trough taken before 2 nd dose, <5 mg/l. Repeat at least every 7 s. Levels >3mg/L should be discussed with a CF doctor AMPHOTERACINliposomal (AmBisome ) Children>1 month: 3mg/kg once daily (Paediatrics start courses with 3mg/kg, omitting Day 1 and 2). Adults Day 1: 1mg/kg daily Day 2: 2mg/kg daily Day 3 onwards: 3mg/kg daily Where appropriate consider rounding dose to nearest 50mg. IV infusion over 60 Test dose required of 100 micrograms/kg (max 1mg) over 10-15, observe for 30mins then continue treatment. Monitor renal function, potassium, magnesium and phosphate levels at least twice weekly. Caution if used with other nephrotoxic drugs. AZTREONAM 2-18years: 50mg/kg three or four times a 2g 2.5gram three times a. short infusion over CASPOFUNGIN Child 1 18 years: 70mg/m 2 (max. 70mg) on first then 50mg/m 2 (max. 70mg) once daily; increased to 70mg/m 2 (max. 70mg) daily if lower dose tolerated but inadequate response 70mg daily on the first followed by 50mg daily. IV infusion over 60 Restricted use only on microbiology advice. If > 80kg, increase daily dose to 70mg od. Reduce dose in hepatic impairment. Limited evidence for children under 18 years.

2 CEFOXITIN Child: 200mg/kg per, divided into 3 or 4 doses 3g four times a 2g-3g four times a Up to 2g dose can be given as a slow IV bolus over 4-5 Unlicensed, imported drug. Restricted use, only on microbiology advice for rapid growing atypical mycobacteria. CEFTAZIDIME All ages over 1month: 100mg/kg twice daily 6g twice daily Slow IV infusion over 30 Doses 1-2g: slow bolus over 4-5 Doses 2-6g: infuse over Use twice daily for convenience but total daily dose may be given in three divided doses if nausea and vomiting occur. Pregnancy dose: 2g three times a CEFUROXIME 50mg/kg three times a 1.5g three times a 1.5g three times a or IV infusion over 30 For haemophilus influenzae COLISTIMETHATE SODIUM (COLISTIN, Colomycin ) Child: 25,000 units/kg (max: 2 million units) three times a. Over 40kg: 2 million units three times a Adult < 40kg: 1 million units three times a > 40kg: 2 million units three times a Caution when using with other nephrotoxic drugs. See BNF for administration details for a more concentrated solution via Portacaths, if desired. Monitor U&Es weekly 2 million units

3 FLUCLOXACILLIN Prophylaxis (if NBM) 25mg/kg twice daily Treatment 50mg/kg four times a 2g four times a Prophylaxis (if NBM) 1g twice daily Treatment Up to 2g four times a or short infusion (infusion for doses >50mg/kg or single dose of 2g) FLUCONAZOLE 1month - 18years: 6-12mg/kg (max: 800mg) daily 400mg on the first followed by mg daily. Intermittent IV infusion Give at rates up to 5-10mL/minute Used in adults for port infection and PUO with teicoplanin FOSFOMYCIN Age >1year: mg/kg four times a 4g 4g four times a IV infusion over at least 30. To treat exacerbations of chronic PA infection in combination with other agents (usually a beta-lactam) when allergy/toxicity has limited options and/or patients have failed on first line therapy. 4g four times a contains 224mmols of sodium per. Consider using a lower dose if patient has cardiac/fluid retention problems etc. IMIPENEM Under 40kg: 25mg/kg four times a Over 40kg: 1g three or four times a 1g Adults- NTM: 500mg four times a 1g three times a Note lower adult dose due to intolerance of higher doses IV infusion: 250 to 500mg (as imipenem) over 20 to 30. Doses over 500mg (as imipenem) over 40 to 60.

4 MEROPENEM PIPERACILLIN/ TAZOBACTAM TEICOPLANIN 1month-12years: 40mg/kg (max 2g) three times a Over 12years: <40kg: 40mg/kg three times a >40kg:2g three times a [Dose is based on maturation of renal excretion pathways and weight. Therefore for patients >12yrs but under 40kg prescribe as 40mg/kg tds.] 2g 1month-11years: 90mg/kg (max: 4.5g) three or four times a 12-18years 4.5g three or four times a 4.5g 1month-11years: 10mg/kg (max: 400mg), 12 hourly for first 3 doses then 10mg/kg once daily. 12years-Adult: 400mg 12 hourly for first three doses, then once daily. 2g three times daily Short infusion over g three or four times a. 400mg 12 hourly for first three doses, then once daily. Short infusion over 30. In 2012 the BNFc changed its advice and for the high doses used in CF the drug should be given by infusion, due to the limited safety data to support 40mg/kg as a bolus. However, where necessary e.g. home IV therapy, it is possible to give as a slow bolus injection, as it is practice in other CF Centres. Inpatients must be given as an infusion. In acute severe infection the dose should be given four times a. For home treatment three times a dosing is appropriate. Do not mix with aminoglycoside. Drug levels can be used to optimise treatment. For MRSA, trough before 4 th or 5 th dose, needs to be >20 mg/l. Doses may be increased above 400mg if levels suggest it is necessary. TEMOCILLIN Under 12years 25mg/kg three times a 2g 2g three times a. Slow bolus over 4-5 or infusion over Total daily dose can be divided in two doses if necessary. Over 12 years and adults 2g three times a.

5 TIGECYCLINE Children 8-17years: 1.2mg/kg twice daily (no loading necessary) 50mg twice a Loading dose of 100mg followed by 50mg every 12 hours Infuse over 60 Infuse over Unlicensed in children, little data. Causes profound nausea- regular antiemetics should be prescribed. Not to be used in children under 8 years of age due to the risk of teeth staining. TOBRAMYCIN All ages from 1 month: 10mg/kg once daily 600mg daily IV infusion over 60 Preferably take level immediately before 2 nd dose and weekly thereafter. (i.e.24hours after the 1 st and 8 th dose). Ideal level: <1 mg/l Take level 14 hours after the 2 nd dose and after each week. Ideal level: <2 mg/l Record time of level on request form. VANCOMYCIN Initially 15mg/kg four times a Initial maximum dose: 750mg four times a Use LTHT Adult Vancomycin Prescription Chart for loading and maintenance doses. See LTHT Paediatric Adult Vancomycin Prescription Chart for administration information Use LTHT Paediatric Adult Vancomycin Prescription Chart for dosing and monitoring.