MacPeds

PEDIATRIC
FORMULARY

For drugs prescribed in the NICU please refer to the handbooks available in unit at
both McMaster and St Joseph’s Healthcare.
There is a separate PICU handbook with a drug formulary specific to the PICU.

This document is intended for use at McMaster Children’s Hospital (MCH) only and may not
be applicable elsewhere. While this document is intended to reflect the practice at MCH at
the time of writing, new information may become available. Every attempt has been made to
ensure accuracy but these recommendations should be used in conjunction with good
clinical judgment, and in consultation with a Pharmacist as needed.

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 Unapproved Abbreviations, Symbols and Dose Designations and Acceptable Corrections

Unapproved Intended Problem Acceptable

Abbreviation Meaning Correction
U Unit Mistaken for “0” (zero), “4” (four), or cc. Use 'unit'.
IU International Mistaken for “IV” (intravenous) or “10” (ten). Use 'unit'.
unit
Abbreviations for Misinterpreted because of similar abbreviations for multiple Do not abbreviate
Drug Names drugs; e.g., MS, MSO4 (morphine sulphate), MgSO4 drug names.
(magnesium sulphate) may be confused for one another. (exceptions: ASA,
KCl, Humulin R)
QD Every day QD and QOD have been mistaken for each other, or as Write “daily” and
QOD Every other day ‘qid’. The Q has also been misinterpreted as “2” (two). “every other day”
in full
OD Every day Mistaken for “right eye” (OD = oculus dexter) Write “daily”
OS, OD, OU Left eye, right May be confused with one another. Use “left eye”, “right
eye, both eyes eye” or
“both eyes”.
AS, AD, AU Left ear, right May be confused with one another. Use “left ear”,
ear, both ears “right ear” or “both
ears”
D/C Discharge or Premature discontinuation of medications if D/C (intended Use “discharge” and
discontinue to mean “discharge”) has been misinterpreted as "discontinue".
“discontinued” when
followed by a list of discharge medications
SC, SQ, or sub q Subcutaneous SC mistaken as SL (sublingual); SQ mistaken as “5 every;” Use "subcut" or
the “q” in “sub q” has been mistaken as “every” (e.g., a "subcutaneous"
heparin dose ordered “sub q 2 hours before surgery”
misunderstood as every 2 hours before surgery)
cc Cubic centimetre Mistaken for “u” (units). Use “mL” or
“millilitre”.
μg Microgram Mistaken for “mg” (milligram) resulting in one thousand-fold Use “mcg or
overdose. microgram”.
Unapproved Intended Potential Problem Acceptable
Symbol Meaning Correction
@ at Mistaken for “2” (two) or “5” (five). Use “at”. Write out “at” in full
> Greater than Mistaken for “7”(seven) or the letter “L” . Write out “greater
than” in full
< Less than Confused with each other. Write out “less than”
in full
Unapproved Intended Potential Problem Acceptable
Dose Meaning Correction
Designation
Trailing zero X.0 mg Decimal point is overlooked resulting in 10-fold dose error.Never use a zero by
Or 10.0 mg itself after
a decimal point.
Use “X mg or 10
mg”
Lack of leading . X mg Decimal point is overlooked resulting in 10-fold dose error. Always use a zero
zero before a
decimal point. Use
“0.X mg”
Adapted from ISMP’s List of Error-Prone Abbreviations, Symbols, and Dose Designations (2010) and ISMP Canada’s Do Not
Use – Dangerous Abbreviations, Symbols and Dose Designations (2006)

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 Legend:

GAS Group A Streptococcus

GP Gram Positive
GPC Gram Positive Cocci Adjust dosing
GN Gram Negative interval for patients
GNB Gram Negative Bacilli with renal impairment.
MAX Maximum
MIN Minimum
NF Non-Formulary At HHS

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 Safer Order Writing

To reduce the potential for medication errors:

 Write orders clearly and concisely.
 Write medication orders using generic drug names only.
 Be careful with mg/kg/DAY vs mg/kg/DOSE.
 Include the intended dose per kilogram on each order.
 Write the patients weight on each order sheet.
 Never place a decimal and a zero after a whole number (4.0 mg
should be 4 mg) and always place a zero in front of a decimal point
(.2mg should be 0.2 mg). The decimal point has been missed and
tenfold overdoses have been given.
 Never abbreviate the word unit. The letter U has been
misinterpreted as a 0, resulting in a 10 fold overdose.
 Always order medications as mg, not mL as different
concentrations may exist of a given medication. There are a few
exceptions such as co-trimoxazole (Septra®).
 QD is not an appropriate abbreviation for once daily, it has been
misinterpreted as QID. It is best to write out “once daily” or “q24h.”
 Do not abbreviate drug names (levo, 6MP, MSO4, MgSO4, HCTZ).
 Do not abbreviate microgram to g, use mcg, or even safer, write
out microgram or use milligrams if possible (0.25 mg instead of
250 micrograms)

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  ANTIBACTERIALS
CELL WALL SYNTHESIS INHIBITORS (BACTERICIDAL)
-LACTAMS
PENICILLINS
benzyl penicillin: narrow spectrum; NOT Penicillinase resistant
Penicillin G (IV or IM) Moderate to Severe Infections:
IV: 100 000 - 400 000 Units/kg/DAY ÷ q4-6h (MAX: 24 million Units/DAY)
Penicillin V Meningitis: IV: 400 000 Units/kg/DAY ÷ q4h (MAX: 24 million Units/DAY)
Potassium (PO)
Suspension: 60mg/mL Penicillin V Potassium (oral):
Tablet: 300mg 1. Mild to moderate Group A Strep infections: 25-50mg/kg/day PO ÷ q8-12h x 10 days
 IDSA (GAS pharyngitis)– Children: 300mg bid-tid; Adolescents & adults: 600mg po BID x 10
days
Penicillin V 500 000 units is
equivalent to 300 mg.
2. Rheumatic fever (treatment): < 27kg: 300mg PO bid x 10 days; > 27kg: 600mg
PO BID x 10 days
3. Rheumatic fever (prophylaxis AND > 5 yrs): 300mg PO bid
4. Prophylaxis in asplenics:
6 months – 5 yrs: 150mg PO bid
>5 yrs: 300mg PO bid

isoxazoyl penicillin: narrow spectrum; Penicillinase resistant

Cloxacillin (IV or PO) Primarily used in methicillin-sensitive Staphylococcus aureus (MSSA) infections:
IV: 100-200 mg/kg/DAY  q4-6h (MAX: 12 g/DAY); up to 300mg/kg/DAY may be used in
Oral: select cases (please consult Infectious Diseases)
Suspension 25mg/mL
Capsule: 250mg, 500mg
PO: Suggest to use cephalexin (1st generation cephalosporin) in place as cloxacillin has low
oral bioavailability, poorly tolerated (GI side effects) and need to be taken on an empty
stomach

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Aminopenicillin: Penicillinase sensitive
Ampicillin (IV) Meningitis: IV: 300-400 mg/kg/DAY  q4-6h (MAX: 12 g/day)
Other infections: IV: 100-200 mg/kg/DAY  q6h (MAX: 2 g/DOSE)
For coverage against Streptococcus pneumoniae (including empiric therapy for community-
Amoxicillin (PO) acquired pneumonia or otitis media): PO 80-90mg/kg/DAY  q8h (MAX: 1 g/DOSE)
Standard dose: PO: 40-50 mg/kg/DAY  q8h
Suspension: 50mg/mL
(supplied at HHS);
GAS pharyngitis: PO: 50mg/kg ONCE daily (MAX: 1000mg/DOSE)
25mg/mL
OR 25mg/kg (MAX: 500mg/DOSE) BID
Clavulanic Acid: Enhances spectrum; beta-lactamase inhibitor
Amoxicillin + Clavulanic Acid For coverage against Streptococcus pneumoniae (i.e. sequential oral therapy in
(Clavulin) (PO) complicated CAP, AOM, sinusitis): 80-90mg/kg/DAYof amoxicillin component
 q8h
Tablets (amoxicillin/clavulanic acid): **BID dosing may be adequate for AOM, but TID dosing is recommended for
500/125mg(4:1); 875/125mg(7:1) pneumonia**

Beginning in fall 2014:

Suspension (supplied as HHS): 1 mL Standard dosing for other gram positive, gram negative, anaerobic infections:
= 80mg amoxicillin and 11.4mg PO: 30-50 mg/kg/DAY of amoxicillin component  q8-12h (MAX: 500 mg/DOSE)
clavulanic acid (7:1)
*One major side effect with clavulanic acid (particularly at high doses) is GI
intolerance
**When writing discharge prescription and if suspension is required, please indicate
(particularly if high dose amoxicillin is used) the formulation of the amoxicillin-
clavulanic acid is specified. Example of prescription:
Amoxicillin clavulanic acid suspension
Please dispense as 7:1 formulation (80mg/mL amoxicillin + 11.4mg/mL clavulanic
acid) 480mg (of amoxicillin component) po TID x 10 days

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  ANTIBACTERIALS (CONTINUED)
PENICILLINS (CONTINUED)
Ureidopenicillin: broad spectrum; Penicillinase sensitive Tazobactam: Enhances spectrum; β-lactamase inhibitor
Piperacillin (IV) For documented Pseudomonas aeruginosa infections

IV: 200-300 mg/kg/DAY ÷ q6h (MAX: 16 g/DAY)

Piperacillin + Tazobactam (IV) Broad coverage against many pathogens. First line for febrile neutropaenia.
IV: 200-300 mg/kg/day (of Piperacillin component) ÷ q6-8h
(Adult dose is 4.5g IV q8h)
**Order antibiotic as x mg (or g) of piperacillin component IV q6-8h**
CEPHALOSPORINS – do NOT cover MRSA, Enterococcus species, Listeria, or extended spectrum beta-
lactamase producing organisms (ESBL)
1st Generation Excellent coverage against S. aureus, group A Streptococcus, E. coli, Klebsiella.
Empiric therapy for cellulitis, osteomyelitis, bacterial adenitis.
Cefazolin (Ancef) IV: 75-150 mg/kg/DAY ÷ q8h (MAX: 6 g/DAY)
(IV or IM) Higher doses are needed for infections such as osteomyelitis
Cephalexin (Keflex) PO: 25-100 mg/kg/DAY ÷ qid
(PO)
Tablet: 250mg, 500mg Osteomyelitis following IV therapy: 100-150mg/kg/DAY (MAX: 4 g/DAY)
Suspension: 50mg/mL
nd
2 Generation NO LONGER INDICATED FOR EMPIRIC TREATMENT OF PNEUMONIA. These
agents offer no benefit compared to ampicillin/amoxicillin for treatment of S.
pneumoniae. Main benefit is coverage against (nontypeable) H. influenzae and
Moraxella, which cause sinusitis and otitis.
Cefuroxime IV: 100-150 mg/kg/DAY ÷ q8h (MAX: 2g/DOSE)
(IV or IM)

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 Cefuroxime Axetil Poor oral bioavailability; unlikely to achieve optimal concentrations in severe
(Ceftin) (PO) infections
Cefprozil (eg. for otitis media unresponsive to high-dose amoxicillin or for acute sinusitis)
(Cefzil) (PO)
Tablet: 250mg, 500mg PO: 15-30 mg/kg/DAY ÷ q12h (MAX: 1 g/DAY).
Suspension: 50mg/mL
3rd Generation Broad spectrum activity against gram negatives. Ceftriaxone/cefotaxime offer
excellent coverage against Streptococcus pneumoniae and good coverage of
methicillin sensitive S. aureus. Only ceftazidime is active against Pseudomonas
aeruginosa. Useful for CNS infections.
Cefotaxime **reserved for neonates**
(IV or IM) Meningitis: IV: 200-225mg/kg/DAY ÷ q6h; up to 300mg/kg/DAY ÷ q6h may be
used in infants and older children for this indication (MAX: 12 g/DAY) Other
infections:
IV: 100-200 mg/kg/DAY ÷ q6-8h (MAX: 6 g/DAY)

Neonates greater than 2kg (if less than 2kg, please refer to neonatal dosing
handbook):
0 – 7 days: 100-150mg/kg/DAY IV ÷ q8-12h
> 7 days: 150-200mg/kg/DAY IV ÷ q6-8h

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  ANTIBACTERIALS (CONTINUED)
CEPHALOSPORINS
Ceftriaxone Meningitis: IV/IM: 100mg/kg/DAY divided q12h or q24h (Max: 2g/DOSE)
(IV or IM) Other infections: IV/IM: 50-75 mg/kg q24h (MAX: 2 g/DAY)

STI (gonococcal infection):

>45kg: 250mg IM x 1
Ceftazidime Active against Pseudomonas aeruginosa:
(IV or IM) IV: 75-150 mg/kg/DAY ÷ q8h (MAX: 6 g/DAY)
Cefixime Increasing MIC (minimum inhibitory concentration) against Neisseria gonorrhea;
(Suprax) (PO) avoid use if possible due to increased risk of treatment failure. IM ceftriaxone is
preferable.
Tablet: 400mg
Suspension: 20mg/mL Other infections (Not active against Pseudomonas and poor GP activity):
PO: 8 mg/kg/DAY ÷ q12-24h (MAX: 400 mg/DAY)

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CARBAPENEMS – Very broad spectrum antibiotics (coverage against GP, GN and anaerobes including
extended beta-lactamase producing strains of GN); no coverage against MRSA ** Requires ID endorsement **
Meropenem Meningitis: 40mg/kg/DOSE IV q8h (MAX: 2g/DOSE)
(IV)
Other infections: 20mg/kg/DOSE IV q8h (usual MAX: 1g/DOSE)
Ertapenem 3 months - 12 years : 15mg/kg/DOSE IV q12h (max: 1 gram/DAY)
(IV) >13 years: 1 g IV once daily (max: 1 gram/DAY)

GLYCOPEPTIDES Only active against GP (including MRSA). Use as an alternative for GP coverage in patients
with severe penicillin allergy (i.e. anaphylaxis, angioedema)
Vancomycin Meningitis: IV: 60 mg/kg/DAY ÷ q6h (MAX: 4 g/DAY)
(IV or PO) Other infections (MRSA or Coagulase Negative Staphylococci):
IV: 40-60 mg/kg/DAY ÷ q6-12h (usual MAX: 2 g/DAY)
The IV formulation will Higher doses may be required in patients with suspected/confirmed MRSA infections, or
be provided when individuals who are in clinically severe sepsis
prescribed orally while
in hospital
Infuse over a minimum of 1 hour to avoid Red Man Syndrome; If reaction occurs, increase
infusion time. In patients with known history of Red Man Syndrome, write on order to infuse
over at least 2 hours.
Monitor trough levels in patients with septic shock, proven MRSA infections,
concurrent nephrotoxins, fluctuating renal function or extended treatment courses

Clostridium difficile infection (usually reserved for severe infection or failed metronidazole):
PO: 12.5 mg/kg/DOSE q6h (MAX: 125 mg/DOSE)

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ANTIBACTERIALS (CONTINUED)
Protein Synthesis Inhibitors
VIA 50S Ribosome (Bacteriostatic)
MACROLIDES Atypicals: Mycoplasma, Legionella, Chlamydia, H. pylori
GAS and S. pneumoniae infections in patients with severe penicillin allergy (although substantial
macrolide resistance has been observed with these pathogens).
Clarithromycin Useful for mild bacterial pneumonia in adolescents. Also commonly used for atypical
mycobacterial infections.
Tablet: 250mg, 500mg PO: 7.5 mg/kg/DOSE BID (Max: 500mg/DOSE)
Suspension:
25mg/mL, (50mg/mL
not available at HHS) Rx Interactions: theophylline, carbamazepine, cisapride, digoxin, cyclosporine, tacrolimus.
Azithromycin Useful for known atypical respiratory infections and bacterial enteritis. AVOID USING TO
TREAT INFECTIONS PRESUMED TO BE CAUSED BY GROUP A STREPTOCOCCUS OR
Tablet: 250mg PNEUMOCOCCUS.
Suspension:
PO/IV: 10 mg/kg (MAX: 500 mg) once, then 5 mg/kg (MAX: 250 mg) q24h for 4 days
40mg/mL

Pertussis: 10 mg/kg PO/IV q24h for 5 days

Chlamydia trachomatis urethritis or cervicitis:
PO: (> 1 month) 12 – 15mg/kg once (MAX: 1g)
LINCOSAMIDES Useful for toxic shock syndromes, anaerobic infections of the head and neck, and for
susceptible S. aureus (including some MRSA) and group A streptococcus infections. Be careful
– resistance in S. aureus is not particularly uncommon!
Clindamycin IV: 30-40 mg/kg/DAY ÷ q8h (usual MAX: 600 mg/DOSE; 900mg IV q8h is usually prescribed
in the setting as adjunct therapy in gram positive toxic shock or necrotizing fascitis)
Capsule: 150mg, PO: 10-30 mg/kg/DAY ÷ q6-8h (MAX: 450 mg/DOSE)
300mg May potentiate muscle weakness with neuromuscular blockers. Oral suspension is very poorly
Suspension
tolerated, avoid if possible, use 150 mg capsules or an alternative antibiotic
15mg/mL

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VIA 30S and 50S Ribosome (Bacteriocidal)
AMINOGLYCOSIDES GN Aerobes (including Pseudomonas aeruginosa)
Gentamicin IV: 5-6 mg/kg/dose q24h (extended frequency dosing is preferred in patients without
renal impairment to maximize pharmacokinetics and dynamics of drug)
OR
Synergy with beta-lactams for severe S. aureus and Enterococcus infections:
Tobramycin 3mg/kg/day IV ÷ q8h

Tobramycin: doses as high as 10mg/kg/DAY IV q24h is recommended in patients with cystic

fibrosis.

(Inhaled tobramycin for CF patients): 80mg bid to tid via inhalation

Once daily dosing should be used for all patients > 1 month of age, except in the
treatment of endocarditis and in patients with extensive burns. Ototoxicity and
nephrotoxicity may occur, consider monitoring trough levels (target <1 mg/L) in
patients at risk for nephrotoxicity (e.g. septic shock, concurrent nephrotoxins, fluctuating
renal function or extended treatment courses). Prolonged therapy (i.e. >/= 2 weeks)
generally not warranted. May potentiate muscle weakness with neuromuscular blockers.
DNA Complex Damaging Agents (Bactericidal)
METRONIDAZOLE (IV or PO) Tablets: 250mg; Suspension: 15mg/mL
Anaerobic infections: IV/PO: 20-30 mg/kg/DAY ÷ q8-12h (MAX: 1 g/DAY)
C. difficile (For Colitis): (Enteral administration preferred but IV can be used)
IV/PO: 30-50 mg/kg/DAY ÷ q6-8h (MAX: 1.5 g/DAY)
Excellent oral absorption, use IV only if PO contraindicated or not tolerated

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  ANTIBACTERIALS (CONTINUED)
Folic Acid Metabolism Inhibitors (Bacteriostatic)
TRIMETHOPRIM-SULFAMETHOXAZOLE (TMP-SMX) (Septra, Co-trimoxazole)
Useful for: Pneumocystis carinii, Toxoplasma, Shigella, Salmonella, MRSA (in settings of cellulitis after appropriate
incision and drainage), Nocardia
Order in mg of trimethoprim component and mL of suspension (or number of tablets)

Bacterial infections (UTI):

PO/IV: 8-12 mg/kg/DAY (of Trimethoprim component) ÷ q12h
Pneumocystis jiroveci pneumonia (PCP):
PO/IV: 15-20 mg/kg/DAY (of Trimethoprim component) ÷ q6-8h
If PCP is severe (i.e. hypoxia), consider adding IV Methylprednisolone 1 mg/kg q24h
PCP prophylaxis (Hematology/Oncology, HIV):
PO/IV: 3-5mg/kg/day (of Trimethoprim component) ÷ bid on Monday, Wednesday, Friday

Urinary tract infection prophylaxis: 2 – 5mg /kg/DAY trimethoprim once daily

Formulation:
Trimethoprim Sulfamethoxazole
Suspension 8 mg/ml 40 mg/ml
Injectable 16 mg/ml 80 mg/ml
SS (single strength) 80 mg 400 mg
Tablet
DS (double strength) 160 mg 800 mg
Tablet

Excellent oral absorption, use IV only if PO contraindicated. Maintain good fluid intake and urine output.
Monitor CBC and LFTs. Do not use in patients with G-6-PD deficiency.

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DNA Gyrase Inhibitors (Bactericidal)
QUINOLONES Enteric GNB, including most ESBL and Pseudomonas. Levofloxacin also has excellent
coverage against S. pneumoniae.
Theoretical risk of development of arthropathy in children is based primarily on animal
studies. The use of quinolones in situations of antibiotic resistance where no other agent
is available is reasonable, weighing the benefits of treatment against the low risk of
toxicity of this class of antibiotics. Another situation would be where there are no other
orally administered antibiotics available.
Ciprofloxacin ** REQUIRES ID ENDORSEMENT**
(IV or PO) Ciprofloxacin usually reserved for infections caused by Pseudomonas aeruginosa or
Tablet: 250mg, 500mg, other resistant gram negative bacilli
750mg
IV/PO: 20-30 mg/kg/DAY ÷ q12h (MAX: 400 mg/DOSE IV or 750 mg/DOSE PO)
Suspension: 100mg/mL
(tablets are preferable if dose Excellent oral absorption, use IV only if PO contraindicated.
is given via NG tubes) Feeds, formula, calcium, magnesium, iron, antacids and sucralfate reduce
absorption, hold feeds for 1 hour before and 2 hours after dose.
Levofloxacin ** REQUIRES ID ENDORSEMENT**
Tablet: 250mg, 500mg, Levofloxacin usually reserved for infections caused by Pseudomonas aeruginosa, other
750mg resistant gram negative bacilli or penicillin-resistant Streptococcus pneumoniae.

Suspension not available

commercially; use dissolve
and dose

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ANTIFUNGALS
Fluconazole (IV or PO) Oropharyngeal candidiasis: IV/PO: 3 mg/kg q24h
Esophageal candidiasis: IV/PO: 6 mg/kg q24h (MAX: 400 mg/DAY)
Candidemia: IV/PO: 12 mg/kg once (MAX: 800 mg) Then
6 mg/kg/DAY (MAX: 400 mg/DAY,  doses
used)
Excellent oral absorption, use IV only if PO contraindicated.
May increase serum levels of cyclosporine, midazolam, cisapride, phenytoin.
Aspergillus species and Candida krusei are intrinsically resistant,
Candida glabrata may respond to higher doses.
Dosage adjustment is required in patients with impaired renal function

Voriconazole (IV or PO) ** Requires ID endorsement **

Tablet: 50mg, 200mg Coverage against many Candida species and Aspergillus
Suspension: 40mg/mL
Loading dose:6mg/kg Q12h x 2 doses then

Maintenance dose: 4mg/kg q12h

(higher doses may be used in specific clinical scenarios)

Only IV formulation needs to be used with caution in patients with renal impairment (use
oral formulation in this scenario)

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ANTIFUNGALS (continued)
Liposomal ** Requires ID endorsement **
Amphotericin B (IV) Coverage against many Candida species, Aspergillus and most Mucor
(Ambisome)
3 – 5 mg/kg IV once daily

Monitor renal function and electrolytes (particularly potassium and magnesium).

Infusion-related adverse effects (e.g. fever, rigors etc) may require pre-treatment
with acetaminophen, diphenhydramine

Caspofungin (IV) ** Requires ID endorsement **

Loading dose: 70mg/m2/DAY IV x 1 dose (MAX: 70mg) then

Maintenance dose: 50mg/m2/DAY IV once daily (MAX: 50mg)

Nystatin Oral candidiasis: PO: infants: 100 000 Units swish and swallow QID
children: 250 000 Units swish and swallow QID
adolescents: 500 000 Units swish and swallow QID

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ANTI-VIRALS
Acyclovir Need to monitor kidney function and ensure adequate hydration (especially on high dose
of intravenous therapy). Dosing adjustment is necessary in patients with impaired renal
Tablets: 200mg, 400mg and function
800mg
Suspension: 40mg/mL
Infants 1-3 months: 60mg/kg/DAY IV ÷ q8h (duration will be dependent on organ
involvement – 21 days for CNS and disseminated disease; 14 days for skin and mucous
membrane involvement)

HSV encephalitis (> 3 months to 12 years): 60mg/kg/DAY IV ÷ q8h (MAX: 1g/DOSE)

HSV encephalitis (> 12 years): 30mg/kg/DAY IV ÷ q8h (MAX: 1g/DOSE)

Mild – moderate mucocutaneous HSV infection in immunocompetent hosts:

30-50mg/kg/DAY PO ÷ 3 TO 5 TIMES DAILY

HSV infection in immunocompromised hosts or severe infection (eg. eczema herpeticum):

15-30mg/kg/DAY IV ÷ q8h
PO dosing (following IV therapy): 60-80mg/kg/DAY PO ÷ 3 TO 5 TIMES DAILY

Varicella or zoster in immunocompromised hosts: 30mg/kg/DAY IV q8h

PO dosing (following IV therapy): 80mg/kg/DAY PO ÷ 3 TO 5 TIMES DAILY

Varicella or zoster in immunocompetent host (note that therapy not always indicated):
80mg/kg/DAY PO ÷ 3 TO 5 TIMES DAILY

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 Oseltamivir Usual treatment duration is for 5 days only
**dosage adjustment is necessary in renal impairment**
Available as 75 mg capsules Children > 12 months:
OR 6mg/mL suspension
Weight Treatment dose
< 15 kg 30 mg/dose PO BID
> 15 kg to 23 kg 45 mg/dose PO BID
> 23 kg to 40 kg 60 mg/dose PO BID
> 40 kg 75 mg / dose PO BID

< 12 months (does not apply to premature infants):

3 mg/kg/dose PO BID (if possible, please round to nearest multiple of 3mg)

References: Bradley JS and Nelson JD. Nelson’s Pocket Book of Pediatric Antimicrobial Therapy.
18th edition. 2010.

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 PEDIATRIC FORMULARY
Acetaminophen
Analgesic and antipyretic.
PO/PR: Refer to table for weight based dosing standardization
Can be dosed q4-6h prn

Weight Single Dose

(kg) (mg)
2.5 - 3.9 40
4.0 - 5.4 60
5.5 - 7.9 80
8.0 - 10.9 120
11.0 - 15.9 160
16.0 - 21.9 240
22.0 - 26.9 320
27.0 - 31.9 400
32.0 - 43.9 480
44 – over 650

Acetylsalicylic Acid
Antiplatelet:
PO: 5 mg/kg/DOSE q24h.
Minimum 20 mg, usual maximum 325 mg.
Kawasaki disease:
PO: 80-100 mg/kg/DAY q6h,
reduce dose to 3-5 mg/kg q24h once fever resolves.
Supplied as 80 mg chewable tablets and 325 and 650 mg tablets.

Amlodipine
Calcium channel blocker:
PO: 0.1-0.3 mg/kg/DAY (max 15mg/kg/day
Due to long half life of drug, dose adjustments should be made
every 3-5 days only)

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 Captopril
Angiotensin converting enzyme inhibitor (ACE-I).
PO: 0.1-0.3 mg/kg/DOSE q8h initially
(usual maximum 6 mg/kg/DAY or 200 mg/DAY).
Monitor blood pressure closely after first dose, may cause profound
hypotension. Cough is a common side effect of ACE-I.

Carbamazepine
Anticonvulsant.
PO: 10-20 mg/kg/DAY initially, usual maintenance dose is
20-30 mg/kg/DAY. Divide daily doseq8-12h.
Serum trough concentration target is 17-50 micromol/L (4-11
microgram/mL).

Charcoal
Adsorbent used in toxic ingestions.
PO: 1-2 g/kg once.
PO: Multiple dose therapy 0.5 g/kg q4-6h.
Give via NG if necessary, consider antiemetics.

Chloral Hydrate
Sedative and hypnotic.
Procedural Sedation:
PO/PR: 80 mg/kg 20-45 mins before procedure may repeat
half dose if no effect in 30 minutes (maximum 2
g/dose).
Sedation:
PO/PR: 25-50 mg/kg/DOSE q6-8h (maximum 500 mg q6h
or 1 g hs).
Avoid in liver dysfunction. Tolerance develops and withdrawal may
occur after long-term use. For PR use dilute syrup with water.

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 Codeine: Codeine has now been replaced with Morphine as the
preferred oral narcotic analgesic for acute pain at HHSC due to better
safety profile. Please refer to morphine dosing

Dexamethasone
Corticosteroid.
Acute Asthma:
IV/PO: 0.3 mg/kg/DOSE (usual max 8 mg/DOSE)
Croup:
IV/PO: 0.6 mg/kg ONCE (usual max 12 mg)
Cerebral Edema::
IV/PO: 1-2 mg/kg then 1-1.5 mg/kg/DAY divided Q6H
(usual maximum 16 mg/DAY)
Antiemetic for antineoplastic regimens:
IV/PO: 0.25mg/kg/DAY divided q8h

Discontinuation of therapy greater than 14 days requires gradual

tapering. Consider supplemental steroids at times of stress if patient
has received long-term or frequent bursts of steroid therapy.

Dextrose
Treatment of hypoglycemia:
IV: 0.5-1 g/kg/DOSE:
1-2 mL/kg of 50% dextrose
5-10 mL/kg of 10% dextrose
1 mmol of dextrose (0.2 g of dextrose) provides 2.8 kJ (0.67 kcal).

10/14 21
 Diazepam
Benzodiazepine sedative, anxiolytic and amnestic.
Status epilepticus:
IV: 0.1-0.5 mg/kg/DOSE (usual maximum 5 mg for <5 yrs,
10 mg for >5yrs)
PR: 0.5 mg/kg/DOSE (maximum 20 mg/DOSE).
Skeletal muscle spasms:
PO: 1-2.5mg /DOSE q3-4h prn (May increase gradually as needed)
Fast onset and short duration of action with single doses, duration of
action prolonged with continued use. Withdrawal may occur if
discontinued abruptly after prolonged use. Not recommended for
continuous infusion due to poor solubility. Can give parenteral
preparation rectally, diluted with water.

Dimenhydrinate (Gravol)
Antihistamine used to treat nausea and vomiting.
IV/IM/PO: 0.5 -1 mg/kg/DOSEq4-6h prn
(max 50 mg/DOSE).
Available as 3mg/mL liquid. Please round to nearest 2.5mg dose.

Diphenhydramine (Benadryl)
Antihistamine used primarily to treat urticaria.
IV/IM/PO: 0.5-1 mg/kg/DOSE q6h prn
(maximum 50 mg/DOSE).
Available as 2.5mg/ml elixir. Please round to nearest 2.5mg dose.

Docusate (Colace)
Laxative
PO: 5 mg/kg/DAY once daily or in divided doses BID-QID
(maximum 200 mg/DAY)
Available as 10 mg/mL suspension or 100 mg capsule Suspension is
bitter tasting. Mask taste by diluting with juice or milk/formula.
Please round to nearest multiple of 5mg.

10/14 22
 Domperidone
Prokinetic agent.
PO: 1.2-2.4 mg/kg/DAY q6h (maximum 80 mg/DAY).
Give 15- 30 mins prior to feed/meals and at bedtime

Enoxaparin
Anticoagulant, low-molecular weight heparin.
Treatment:
Subcutaneous:
<2 months of age: 1.5 mg/kg/DOSE q12h.
>2 months of age: 1 mg/kg/DOSE q12h.
Prophylaxis:
Subcutaneous:
<2 months of age: 0.75 mg/kg/DOSE q12h. or 1.5 mg/kg q24h
>2 months of age: 0.5 mg/kg/DOSE q12h or 1mg/kg q24h

Monitor platelets and hemoglobin. Avoid in severe renal

dysfunction. Anti-factor Xa level drawn 4 hours post Subcutaneous
injection should be 0.5-1 unit/mL for treatment and 0.2-0.4 unit/mL
for prophylaxis.

Epinephrine (1:1000)

NEB: If less than 10kg: 2.5mg/DOSE inhaled q8h prn

10kg or greater: 5mg/DOSE inhaled q8h prn

Bronchiolitis:
NEB: 1.5 mg in 4 mls of 3% Hypertonic saline q8h

10/14 23
 Fentanyl
Narcotic analgesic
Continuous infusion:
Initial bolus dose: IV: 0.5-1 mcg/kg then
Continuous infusion: 0.5-2 microgram/kg/hr
Breakthrough: 0.5-1 mcg/kg q1-2h prn
(refer to continuous infusion preprinted order set)
Please note: Fentanyl is 100 x more potent than morphine
To prevent withdrawal, avoid abrupt cessation following high doses
or long duration of therapy (> 5 days). Common adverse effects are
pruritis, nausea and constipation

Ferrous Sulfate : See iron.

Fluticasone (Flovent)
Inhaled corticosteroid.
INH: 50-500 microgram q12h.
Available as 50mcg, 125mcg , 250 mcg /inhalation metered dose
inhaler

Furosemide
Loop diuretic.
PO: 1-2 mg/kg/DOSE q6h-q24h (usual max 80 mg/DOSE)
IV: 0.5-2 mg/kg/DOSE q6h-q24h (usual max 80mg/DOSE)
or
begin at 0.1 mg/kg/hour and titrate to clinical effect
(maximum 0.5 mg/kg/h).
Available as 10mg/mL oral solution. Please round to nearest 1mg dose.

Hydrochlorothiazide
Thiazide diuretic.
PO: 1-4 mg/kg/DAY q12h
Available as 5mg/mL suspension. Please round to nearest 0.5mg or 1mg.

10/14 24
 Hydrocortisone
Corticosteroid.
Acute asthma:
IV: 1-2 mg/kg/DOSEq6h for 24-48 hours then reassess.
(usual max is 5mg/kg/DOSE)
Anaphylaxis:
IV: 5-10 mg/kg/DOSE.
Acute adrenal crisis:
IV: 1-2 mg/kg then:
Infants: 25-150 mg/DAY q6h.
Older children: 150-250 mg/DAY q6h.
Discontinuation of therapy >14 days requires gradual tapering.
Consider supplemental steroids at times of stress if patient has
received long-term or frequent bursts of steroid therapy.

Hydromorphone
Narcotic analgesic
Intermittent Analgesia :
PO: 0.03-0.08 mg/kg/DOSE q4-6h prn
(usual initial max 3mg/DOSE)
IV: 0.01-0.02 mg/kg/DOSE q2-4h prn
Continuous infusion:
Initial bolus dose: IV: 0.01-0.02 mg/kg then
Continuous infusion: 2-8 microgram/kg/hr
Breakthrough: 0.01-0.02 mg/kg q2-4h prn
(refer to continuous infusion preprinted order set)
To prevent withdrawal, avoid abrupt cessation following high doses
or long duration of therapy (> 5 days). Common adverse effects are
pruritis, nausea and constipation

Hydroxyzine
Anti-pruritic:
PO: 2 mg/kg/DAY ÷ TID or QID
Available as a 2mg/mL suspension or 10mg, 25mg capsules

10/14 25
 Hypertonic Saline 3%:
Bronchiolitis
NEB: 4 mls of 3% saline q8h

Ibuprofen
Analgesic and anti-inflammatory (NSAID).
Can be dosed q6-8h prn.
PO:
Weight (kg) Single Dose (mg)
2.5 - 3.9 20
4.0 - 5.4 30
5.5 - 7.9 40
8.0 - 10.9 60
11.0 - 15.9 100
16.0 - 21.9 150
22.0 - 26.9 200
27.0 - 31.9 250
32.0 - 43.9 300
44 – over 400

Avoid in patients with renal impairment or increased risk of bleeding

Insulin (regular)
Recombinant human insulin.
Diabetic ketoacidosis:
IV: 0.05-0.1 units/kg/h initially. (add 25 units of regular
insulin to 250 ml/NS) then titrate to patients response
For IV administration MUST use regular insulin.
Hyperkalemia:
IV: 0.1 units/kg AND dextrose 0.5 g/kg.

Ipratropium (Atrovent)
Inhaled anticholinergic bronchodilator.
Severe asthma:
NEB: 125-250 microgram (0.5-1 mL) q4-6h.
INH: 2-4 puffs q4-6h (1 puff = 20 mcg)

10/14 26
 Iron
Treatment of iron deficiency anemia:
PO: 4-6 mg/kg/DAY (of elemental iron)q8-24h.
Prevention of iron deficiency anemia:
PO: 2-3 mg/kg/DAY (of elemental iron) ÷ q8-24h.

Give with food if GI upset occurs. Does stain teeth, rinse mouth well
after administration.
Available as ferrous sulfate 75mg/mL solution (15mg/mL elemental
iron). Please round to nearest 12.5mg dose (2.5mg elemental iron)

Kayexelate® (Sodium Polystyrene Sulfonate)

Cation exchange resin.
Treatment of hyperkalemia:
PO/PR: 1 g/kg/DOSE may be repeated q4-6h prn
(usual maximum 30-60 g/DOSE).
Give in water or juice, do not mix with fruit juices with high
potassium content such as orange juice.

Ketorolac (Toradol)
Analgesic and anti-inflammatory (NSAID).
IV/IM: 1-2 mg/kg/DAY (maximum 120 mg/DAY) q6h.
Adverse effects include renal dysfunction, GI irritation and
ulceration.

Lactulose
Osmotic laxative.
PO: infants: 2.5-5 mL q8-24h.
children: 5-10 mL q8-24h.
adolescents: 15-30 mL q8-24h.

10/14 27
 Levetiracetam
Anticonvulsant
PO: 5-10 mg/kg/DAY (Daily or BID)
May titrate dose to effect (max 3000mg/DAY), may require
dosage adjustment in renal impairment

Lorazepam
Benzodiazepine sedative, anxiolytic and amnestic.
Status epilepticus:
IV: 0.1 mg/kg/DOSE, (usual maximum 4 mg/DOSE).
May repeat 0.1mg/kg in 5 mins if needed
PR: 0.2 mg/kg/DOSE (usual maximum 8 mg/DOSE)

Pre-op/procedural sedation:
PO/SL: 0.05 mg/kg/dose (max 4mg/DOSE)
IV: 0.03-0.05 mg/kg/dose (max 4 mg/DOSE).

Intermediate duration of action and no active metabolites.

Withdrawal may occur if discontinued abruptly after prolonged use.
Not recommended for continuous infusion due to poor solubility.
May give parenteral preparation rectally, diluted with water.

Magnesium salts
Electrolyte.
Treatment of hypomagnesemia:
PO: 20-40mg/kg/day elemental magnesium ÷ TID-QID
IV: 25-50 mg/kg (maximum 5g) over 4-5 hours
Severe acute asthma:
IV: 25-75 mg/kg/DOSE once (usual maximum 2g/DOSE)

IV available as magnesium sulfate. PO available as magnesium

glucoheptonate oral liquid 100mg/mL (5mg/mL elemental Mg) or
magnesium oxide 420mg tablet (252mg elemental Mg)

10/14 28
 Methylprednisolone
Corticosteroid.
Severe acute asthma:
IV: 0.5-1 mg/kg/ DOSE q12h (usual max 40 mg/DOSE)
Or
1-2 mg/kg/DOSE q6h can be used until improvement
seen (usually 24-48 hours) then q24h or switch to oral
prednisone.
Anti-inflammatory:
IV: 1-2 mg/kg/DOSE q24h.
High dose/pulse therapy:
IV: 10-30 mg/kg/DOSE q24h

Discontinuation of therapy >14 days requires gradual tapering.

Consider supplemental steroids at times of stress if patient has
received long-term or frequent bursts of steroid therapy.

Metoclopramide
Antiemetic, gastrointestinal prokinetic agent.
IV/PO: 0.4-0.8 mg/kg/DAY q6h
(usual maximum 40 mg/DAY).
Extrapyramidal reactions occur more commonly in children and may
be treated with diphenhydramine.

10/14 29
 Morphine
Narcotic analgesic.
Intermittent Analgesia :
PO: 0.2-0.5 mg /kg/DOSE q4-6h prn
(usual max is 10-15 mg/ DOSE)
IV: 0.05-0.1 mg/kg/DOSE q2-4h prn and increase as required
Continuous infusion:
Initial bolus dose: IV: 0.05-0.1 mg/kg then
Continuous infusion: 10-40 microgram/kg/hr
Breakthrough: 0.05-0.08 mg/kg q2-4h prn
(refer to continuous infusion preprinted order set)

Please note: Morphine has now replaced codeine as the

preferred oral narcotic analgesic for acute pain at HHSC due to
better safety profile. Reduced doses may be required if used in
combination with benzodiazepines. To prevent withdrawal, avoid
abrupt cessation following high doses or long duration of therapy
(> 5 days). Common adverse effects are pruritis, nausea and
constipation

Naproxen
Analgesic and anti-inflammatory (NSAID).
PO: 10-20 mg/kg/DAY q8-12h (maximum 1 g/DAY).
Adverse effects include renal dysfunction, GI irritation and
ulceration.

Nifedipine
Anti-hypertensive
PO/SL: 0.125-0.25 mg/kg/DOSE (max 10mg/dose)
(use immediate release capsules)
Nurse to use needle to withdraw liquid from 10 mg capsule. Each
1mg = 0.03mL.

10/14 30
 Omeprazole
Inhibitor of gastric acid secretion (proton pump inhibitor).
PO: 1-2 mg/kg/DAY q12-24h (maximum 40 mg/DAY).
A 2mg/mL oral suspension is available. Please round to nearest 1mg dose.

Ondansetron
Antiemetic.
IV/PO: 0.1-0.15 mg/kg/DOSE q8h prn
(maximum 8 mg/DOSE).

Oxybutynin
Urinary antispasmotic agent.
PO: 1-5 years: 0.2 mg/kg/dose BID-QID
>5 years: 5mg/DOSE BID-QID
Available as 1mg/mL syrup or 5mg tablets

Pantoprazole
Inhibitor of gastric acid secretion (proton pump inhibitor).
PO/IV: 1-1.5 mg/kg/DAY ÷ q12-24h (usual max 40 mg/DOSE)

GI bleed:
IV: 5 – 15 kg: 2 mg/kg/DOSE x 1 DOSE, then 0.2 mg/kg/h
16 – 40 kg: 1.8 mg/kg/DOSE x 1 DOSE, then 0.18 mg/kg/h
> 40 kg: 80 mg x 1 DOSE, then 4 - 8 mg/h

There is no liquid formulation available. Intravenous and oral

pantoprazole provide equivalent acid suppression. Do not crush
tablets. IV infusion is available as 40 mg in 50 mls of NS

10/14 31
 PEG-3350 (Polyethylene Glycol)
Osmotic Laxative
Constipation:
PO: 0.5-1 g/kg/DAY
( titrated to effect up to a usual max of 17 g/day)
Available as 17 gram /sachet in hospital. Mix in 125-250 mL of water
or juice. Onset 2-4 days. May titrate to effect up to a usual max of 17
g/DAY . Is odorless and tasteless.

Phenobarbital
Barbiturate anticonvulsant.
Status epilepticus:
IV: 20 mg/kg over 20-30 minutes.
Maintenance:
IV/PO: 3-5 mg/kg/DAY  q12-24h.
Usual serum level for seizure control: 65-172 micromol/L (15-40
mg/L)

Phenytoin
Anticonvulsant
Status epilepticus:
IV: 20 mg/kg over 20 minutes.
Maintenance:
IV/PO: 5 mg/kg/DAY (range 3-10 mg/kg/DAY)  q8-12h.
May require higher doses for patients with head injuries. Must be
diluted in saline only and requires in-line filter (0.22 micron). Hold
feeds before and after enteral administration as continuous feeds and
formula may decrease bioavailability of oral products. Significantly
increased free fraction in patients with hypoalbuminemia may result
in underestimation of effective drug concentration and difficulty in
interpretation of drug levels and toxicity may occur at “therapeutic”
serum levels. Therapeutic level: 40-80 micromol/L (10-20
microgram/mL).

10/14 32
 Phosphate salts:
Electrolyte
Treatment of hypophosphatemia:
PO: 1-2 mmol/kg/day ÷ BID-QID
IV: 0.15-0.64 mmol/kg (maximum 30mmol) over 4-6 hours

IV available as sodium phosphate (3mmol phosphate + 4 mmol

sodium/mL) and potassium phosphate (3mmol phosphate + 4.4
mmol potassium/mL). PO available as IV formulation of potassium
phosphate (see above), given PO and Phosphate Novartis 500mg
effervescent tablet (16 mmol phosphate/3mmol potassium per
tablet). Order in mmol phosphate component.

Dose recommendations assume normal renal function. Please refer

to Pediatric IV monograph for further prescribing details and
limitations

Pico-Salax® (picosulfate sodium/magnesium oxide/citric acid)

Stimulant and Osmotic Laxative
PO: 1-6 yrs administer ¼ sachet
6-12 yrs administer ½ sachet
Over 12 yrs: 1 sachet
Dose can be repeated after 6-8hours if no effect
Used for refractory constipation, fecal impaction and for cleaning out
bowels. Contents of 1 sachet are mixed with 160mL water.

10/14 33
 Potassium Salts
Electrolyte. 1mmol of potassium chloride = 1 mEq of potassium
chloride
Treatment of hypokalemia:
PO: 1-2 mmol/kg/DAY  q6h-24h.
IV: 0.25-0.5 mmol/kg/DOSE.
For PO administration potassium chloride is available as oral
solution 1.33 mmol/mL, and slow release tablets (Slow K) 600 mg
(= 8 mmol). Potassium citrate is also available as effervescent tablet
(25 mEq/tablet). Give po with food. Dilute oral solution in water or
juice and give over 5-10 mins. Slow-release tablets should not be
crushed or chewed.
Usual adult maximum = 80 mmol/DAY

Risk of arrhythmias and cardiac arrest with rapid IV administration.

Dose recommendations assume normal renal function. Please refer
to Pediatric IV monograph for further prescribing details and
limitations
Prednisone or Prednisolone
Corticosteroid.
Acute asthma:
PO: 1-2 mg/kg/DOSE q24h.
Anti-inflammatory or immunosuppressive:
PO: 0.5-2 mg/kg q24h (usual max is 60mg/DAY)

1 mg Prednisone = 1 mg Prednisolone. Discontinuation of therapy

greater than 14 days requires gradual tapering. Consider supplemental
steroids at times of stress if patient has received long-term or
frequent bursts of steroid therapy.

10/14 34
 Ranitidine
H2 receptor antagonist.
Reduction of gastric acid secretion:
IV: 2-4 mg/kg/DAY q8-12h (usual max 50 mg q8h).
PO: 4-10 mg/kg/DAY q8-12h (usual max 300 mg/DAY).
IV dose is approximately 50% of oral dose. Modify dosage interval
for patients with renal impairment. May add IV daily dose to TPN.
Available as a 15mg/ml oral solution.

Salbutamol (Ventolin)
Bronchodilator, 2 agonist.
Acute asthma:
MDI: 4-8 puffs q ½-q4h prn.
NEB: Less than 10 kg: 2.5 mg q ½-q4h prn
10 kg or greater: 5 mg q½-q4h prn
Administered in 3 mL of NS.
Available as 5 mg/mL solution for nebulization.

Maintenance therapy:
MDI: 1-2 puffs q4h prn.
Titrate dose to effect and/or adverse effects (tachycardia, tremor and
hypokalemia). For most patients metered dose inhalers with a spacer
device are the preferred method of drug delivery.

Senna
Stimulant laxative.
PO: infants: 1 or 2.5 mL (1.7 or 4.25 mg) q24h.
children: 2.5 or 5 mL (4.25 or 8.5 mg) q24h.
adolescents: 5 or 10 mL (8.5 or 17 mg) q24h.
Some patients, particularly those receiving opiates may require higher
doses and/or more frequent administration. Also supplied as 8.6 mg
tablets.

10/14 35
 Spironolactone
Potassium sparing diuretic.
PO: 1-3 mg/kg/DAY q12-24h.
Available as a 5mg/mL suspension. Please round doses to the nearest
0.5mg or 1mg.

Topiramate
Anticonvulsant
For greater than 2 yrs and less than 16 yrs:
PO: 1-3 mg/kg/DAY as a single dose
(initial max 25 mg/DAY)
then can increase dose at 1-2 week interval by 1-3 mg/kg/DAY
divided q12h.
Usual maintenance
PO: 5-9 mg/kg/DAY divided q12h

17 years and older :

PO: 25 to 50 mg/DAY as a single dose , may increase dosage
by 25 to 50 mg/DAY at 1-week intervals, give q12h. .
Titrate dose to response to a usual maintenance dose of 200 to
400 mg/DAY divided q12h

Ursodiol
TPN Cholestasis:
PO: 30mg/kg/DAY divided q8h
Biliary Atresia:
PO: 10-15 mg/kg/DAY once daily

10/14 36
 Valproic Acid and Derivatives
Anticonvulsant.
Maintenance
PO: 15-20 mg/kg/DAY increased to a maximum of
30-60 mg/kg/DAY q6-12h.
Desired therapeutic range: 350-700 micromol/L (50-100
microgram/mL).
Dosing is equivalent for valproic acid, divalproex and sodium
valproate.
Valproic acid IV is special access only and reserved for specific
indications. Please consult pharmacist.

Vitamin K
Reversal of prolonged clotting times or warfarin induced
anticoagulation.
IV/PO: 0.5-10 mg/DOSE.
Use lower doses if there is no significant bleeding and patient will
require warfarin in the future. May repeat in 6-8 hours. Injection
may be given by mouth, undiluted or in juice or water.
Zinc Sulphate
Supplement
PO: 0.5-1 mg elemental zinc/kg/DAY divided q8-12h
(usual max 15mg elemental zinc/DAY)
Available as 10mg/mL elemental zinc suspension, 10mg or 50mg
elemental zinc tablets (as zinc gluconate)

10/14 37
 Approximate Opioid Analgesic Equivalence
at HHS –April 2014
HHS-
Suggested dose equivalency applies March
to stable analgesic 2010
states. Patients with acute
postoperative pain may have variations to suggested conversions.

OPIOID Parenteral Dose Oral Dose

(mg)a (mg)
FentaNYL 0.1 N/A
HYDROmorphone 2 6
Methadone N/Ab 2.5-10b
Morphine 10 30
OxyCODONE N/A 15
These approximate analgesic equivalences should be used only as a guide for estimating equivalent
doses when switching from one opioid to another in chronic pain patients.
If the patient was on high dose opioid therapy (100 mg/day or greater of morphine), initial doses of
the new opioid should be 50% of the calculated dose of the new opioid.
If patient was on moderate dose of opioid therapy ( 60 – 90 mg/day morphine) start with 75% of
calculated dose of new opioid.
Additional references & patient response should be consulted to verify appropriate dosing of individual
agents. Additional resources for dose conversion can be found at:
http://nationalpaincentre.mcmaster.ca/
a
Parenteral route includes intravenous, intramuscular and subcutaneous route, but does not include
intraspinal route.
b.
Methadone equivalency is highly variable – this ratio is taken from Micromedex as suggested
equivalency ratio in patients on chronic oral methadone.

10/14 38
 Approximate Systemic Corticosteroid
Equivalence
at HHS - May 2010
Equivalent Dose Relative Mineralocorticoid
Drug (mg)a Potency
Glucocorticoids:
Short-acting (biologic half-life 8–12 h)
Cortisone 25 2
Hydrocortisone 20 2
Intermediate-acting (biologic half-life 12–36 h)
Methylprednisolone 4 0
Prednisolone 5 1
Prednisone 5 1
Long-acting (biologic half-life 36–54 h)
Dexamethasone 0.75 0
a
Equivalent doses are approximations and may not apply to all diseases or routes of
administration. Duration of hypothalamic-pituitary-adrenal (HPA) axis suppression and
degree of mineralocorticoid activity must be considered separately.

10/14 39
 Antibiotics  Guide  for  Common  Pediatric  Infections  (>3  months)  

Infection   Major  Organisms   Antibiotic   Duration   Notes  

Otitis  Media   S.  pneumoniae,  H.  influenzae  (non-­‐ First  line:   5  days   watchful  waiting  appropriate  when:    
typable),  M.  catarrhalis  (2-­‐20%)   High-­‐dose  Amoxicillin  PO   OR   -­‐ >  6mo  
Group  A  Streptococcus  (5%)   Second  line:   10  days  if:     -­‐ healthy  child  (NO  immunodeficiency  or  chronic  
if  type  1  allergy  à  Clarithromycin  PO   <  2yo,  frequent  recurrent  AOM,   disease  or  anatomical  abnormality  of  head  and  neck,  
if  non-­‐type  1  à  Cefprozil  PO     perforated  TM,  failed  initial  Abx   NO  Down’s  syndrome,  NO  history  of  complicated  
OR  Ceftriaxone  IM  x  1  dose   otitis  media)  
If  initial  therapy  fails:   -­‐ illness  not  severe  
Amoxicillin-­‐Clavulanate  (Clavulin)  PO   -­‐ reliable  parents  
if  type  1  allergy  à  call  ID   CPS  statement  2009  
Community-­‐ 3  mo  –  4  yrs   Outpatient  or  admitted  to  ward:   7-­‐10  days,  depending  on  clinical   Features  of  atypical  pneumonia:  subacute  onset,  non-­‐
acquired   Viral  >  Bacterial  (S.  pneumoniae,   High  dose  Amoxicillin  PO  or  Ampicillin  IV   status   lobar  infiltrate,  minimal  leukocytosis,  school-­‐age  
pneumonia   group  A  Streptococcus)  >>  Atypicals   Atypical  pneumonia:        
(Mycoplasma,  Chlamydophila,   Clarithromycin  PO   (treatment  duration  will  be   -­‐ Macrolides  are  useful  in  pen-­‐allergic  patients  
Legionella)   Pleural  effusion/Admitted  to  PCCU/Necrotizing:   longer  in  the  presence  of   -­‐ If  you  are  sure  it  is  not  a  type-­‐1  reaction,  can  try  
  Ceftriaxone  IM/IV  +  Vancomycin  IV   complications  such  as  empyema)   cephalosporins  (2nd  or  3rd  gen.)  
5  –  18  yrs       -­‐ Consider  risk  factors  for  MRSA  
Bacterial,  Atypicals,  Viral   CPS  statement  2011  

Meningitis     Bacterial  (S.  pneumoniae,  H.  influenza,   Cefotaxime  IV   Depends  on  organism:   Mandatory  ID  consult  
N.  meningitidis),  Viral  (HSV,   OR  Ceftriaxone  IV/IM     S.  pneumonia  10-­‐14  days  
Enterovirus)   PLUS   N.  meningitidis  5-­‐7  days   consider  DEXAMETHASONE  if  bacterial  pathogen  
  Vancomycin  IV     If  CSF  culture  negative  but  strong   suspected  0.6  mg/kg/day  divided  q6h  before  or  within  
Special  considerations  in:     clinical  suspicion  then  continue  
30  minutes  of  the  first  dose  of  antibiotics  (only  
-­‐ <  3mo   ADD  acyclovir  if:   empiric  antibiotics  for  7-­‐10  days  
-­‐ immunocompromised   -­‐ CSF  pleocytosis  <2000  WBC/hpf   continue  for  2  days  if  S.  pneumonia  or  H.  influenza  
  isolated,  any  other  pathogen  discontinue)  
-­‐ known  CNS  disease,  
trauma  
-­‐  Target  vancomycin  trough  levels  10-­‐15  
CPS  statement  2014  
Urinary  Tract   E.Coli,  Klebsiella,  Enterococcus,   Uncomplicated  (cystitis):   No  clear  consensus   -­‐ Diagnosis:  urine  R+M  and  culture  (will  only  send  
Infection   Proteus,  Serratia,  Pseudomonas,   Cephalexin   7-­‐14  days   culture  if  mid-­‐stream,  catheter  or  suprapubic  
S.  Saprophyticus   Sulfamethoxazole/Trimethoprim     aspiration  ie.  NO  BAG  SAMPLES  for  culture)  
  Complicated  (<2-­‐3  months  pyelonephritis   considerations:  age,  anatomy,   -­‐ First  febrile  UTI  in  an  infant  warrants  investigation  
Acronym:  KEEPPSS     systemically  ill  vomiting,  immunocompromised):   complicated  vs.  uncomplicated   with  an  abdominal  ultrasound  
Ampicillin  IV  PLUS  Gentamicin  IV   AAP  Clinical  Practice  Guideline  2011  
OR  Ceftriaxone  IV/IM  

Cellulitis   Group  A  Streptococcus,     First  line:   7-­‐10  days  (usually  1-­‐2  days  after   -­‐ Consider  I&D  as  first  line  if  abscess  or  furuncle  
S.  aureus  (MSSA/MRSA),   1st  generation  Cephalosporin  such  as   the  rash  resolves)   -­‐ Consider  MRSA  risk  factors  
Group  C/G  streptococcus   Cephalexin/Cefazolin       -­‐ avoid  oral  cloxacillin  if  possible  as  it  has  poor  
If  pus  present  –  very  likely  S.  aureus   If  allergic  to  beta-­‐lactam:   Varies  depending  on  presence  of   bioavailability  and  has  GI  side  effects  
Clindamycin  PO/IV   abscess  and  degree  of  drainage    
If  pus  not  present  –  very  likely   If  suspect  MRSA:  
streptococcal   Outpatient  à  Trimethoprim/Sulfamethoxazole  
Inpatient  à  Vancomycin    
Osteomyelitis   S.  aureus,  Group  A  Streptococcus,   First  line:   Prolonged  treatment  course:  4-­‐6   -­‐ mandatory  ID  consult  for  management  and  F/U  
pneumococcus,  kingella   Cefazolin  (high  dose)   wks  (combination  of  IV/PO  as  per   -­‐ consider  special  groups:  eg.  Salmonella  in  sickle  cell  
If  suspect  MRSA:   ID)   disease,  MRSA  colonized,  infected  hardare  
Vancomycin  
Pharyngitis   Viral  >  bacterial  (Group  A  Strep)   If  suspect  GAS:   10  days   -­‐ useful  to  confirm  dx  with  throat  culture  
penicillin  V  or  amoxicillin   -­‐ bacterial  >  viral  if:  cough  absent,  tender  
If  True  beta-­‐lactam  allergy:   lymphadenopathy,  high  fevers,  ++  tonsillar  exudates    
Macrolide  or  Clindamycin  

10/14 40
 Antibiotics  Guide  for  Common  Pediatric  Infections  (>3  months)  
 

CLNICAL  PEARLS  

Other  Clinical  Scenarios:   Challenging  Organisms:   Antibiotics  of  note:    

     
Septic  Shock:     Pseudomonas  covered  by:   MRSA  covered  by:   Organisms  resistant  to  penicillins  and   Vancomycin  (only  covers  gram  +ve),   Carbapenem  indications:  
ceftriaxone  +  vancomycin       cephalosporins:   indications:    
can  consider  pip-­‐tazo  if   -­‐ ceftazidime   -­‐ Vancomycin       -­‐ ESBL  
require  coverage  for   -­‐ piperacillin  +/-­‐   -­‐ Clindamycin   -­‐ MRSA   -­‐ MRSA   -­‐ SPICE  
anaerobes  (eg.  GI  infection)   tazobactam   -­‐ Septra   -­‐ ESBL   -­‐ Severe  C  diff  infection  (PO  only)   -­‐ Polymicrobial  infection  
or  pseudomonas   -­‐ ciprofloxacin  /   -­‐ Linezolid  (needs  ID   -­‐ CONS     -­‐ CONS    
  levofloxacin   endorsement)   -­‐ C  diff   -­‐ Enterococcus     REQUIRES  ID  CONSULT  
Febrile  Neutropenia:     -­‐ meropenem     -­‐ SPICE  (AmpC  producers):  Serratia,  
-­‐ Piperacillin-­‐tazobactam   -­‐ aminoglycosides     Risk  Factors:   providencia,  Indole  +ve  Proteus  
-­‐ Refine  Abx  if  blood  Cx  +ve   (gentamicin/tobramycin/     (Proteus  vulgaris),  Citrobacter,  
-­‐ Consider  previous   amikacin)   -­‐ Previous  MRSA   Enterobacter  cloacae  
microbiology  history  (e.g.     infection  or   -­‐ Atypicals  
antibiotic-­‐resistant   household  contact    
organisms)   -­‐ Healthcare  
  exposure/recent  
hospitalization  
-­‐ TRAVEL  (including  
to  USA)  
 

10/14 41
PPI  (Proton  Pump  Inhibitors)  in  Pediatrics  –  Reflux  Disease  –  Best  Evidence  in  Peds  with  Omeprazole,  Lansoprazole  and  Pantoprazole.  
1,  6   1   3  
Drug   Brand   Pediatric  Dose Max  Dose (faster   Usual    Administration   Available   LU  Code  
( 4  
Generic   Name   BID  dosing  is   clearance  in  peds   Adult   (See  note  below)   Formats and  
Name   thought  to  provide   than  adults  –  may   Dose   Note:   Cost  
5(  
better  control  of   need  higher  than   2   Pharmacy  Prepared  Suspension
GERD (Compounding  dependent  on  pharmacy)  
breakthrough  acid)   standard  adult  
dose)  
Omeprazole   Losec   1-­‐1.5  mg/kg/day  PO   3.5  mg/kg/day     10-­‐20  mg   1.Capsule  –  can  be  opened  &   10mg     293  –  GERD  or  non  erosive  GERD  when  H2Antags  have  failed    
once  daily  or  divided   PO  OD   sprinkled  on  yogurt  and  given   capsules–  not   297-­‐PUD  or  prevention  of  NSAID  induced  ulcers    
BID   2.  Pharmacy  prepared  suspension     ODB  covered   401-­‐  treatment  of  GI  disorders:  Crohns,  short  Gut  etc.    
402-­‐severe  esophagitis,  Zollinger-­‐Ellison  etc.  
NEONATAL:   can  be    used   20  mg    cap  
0.5-­‐1.5  mg/kg/dose     ($0.6/cap)  
 
Lansoprazole   Prevacid   <10  kg:  7.5  mg  PO   1.6  mg/kg/day  or     15-­‐30  mg   1.Capsules  may  be  opened  and   15mg   293  –  GERD  or  non  erosive  GERD  when  H2Antags  have  failed    
OD  10-­‐30  kg:  15  mg   30  mg/day   PO  OD   sprinkled  into  applesauce     ($0.5/cap)   295  –  for  HPylori  Peptic  Ulcer    
PO  OD  >30  kg:  30  mg   2.FasTabs  can  be  placed  on   30mg   297-­‐PUD  or  prevention  of  NSAID  induced  ulcers    
401-­‐  treatment  of  GI  disorders:  Crohns,  short  Gut  etc.    
PO  OD   tongue  for  doses  15mg  or  greater   ($0.5/cap)     402-­‐severe  esophagitis,  Zollinger-­‐Ellison  etc.  
  3.  FasTabs  can  be  mixed  with   with  Enteric  
  water  (10mL)  to  provide  part   coated  
doses  only  if  no  other  options   microgranules  
exist    
4.  Pharmacy  Prepared  suspension   15,  30  mg  
may  be  used  if  available   FasTabs  (not  
ODB  covered)  

Esomeprazole   Nexium   1mo-­‐11  yrs:       40  mg/day   20-­‐40  mg   1.Tabs  can  be  dispersed  for  PO   20  mg,  40  mg   NO  –  Not  covered  under  ODB  
<5kg:2.5-­‐  5mg  PO  OD   PO  OD   admin.  Mix  with  25-­‐50mL  mL  of   tablet  
>5kg:  10  mg  PO  OD   water   10  mg  sachet  
12-­‐17yrs:  20  mg  PO   2.  Sachet  can  be  dissolved  &   for  oral  
OD   administered  via  G  tube   suspension  
  (Not  ODB  
covered)  
Pantoprazole   Pantoloc   1-­‐1.5  mg/kg/day   40  mg/dose   20-­‐40  mg   Cannot  be  crushed   20mg-­‐  not  a   293  –  GERD  or  non  erosive  GERD  when  H2Antags  have  failed  295  –  
PO  OD     benefit   for  HPylori  Peptic  Ulcer  297-­‐PUD  or  prevention  of  NSAID  induced  
ulcers  401-­‐  treatment  of  GI  disorders:  Crohn’s,,  short  Gut  etc.  402-­‐
 40  mg    
severe  esophagitis,  Zollinger-­‐Ellisons  etc.  
($0.5/tablet)  
Rabeprazole   Pariet   Greater    than  10     20  mg  PO   Cannot  be  crushed   10  mg  ($0.17   NO-­‐  Not  Covered  under  ODB  
years:  10  mg  PO  OD     OD     tablet)),  20  mg  
($0.3/tablet)    
Note:  Directions  for  opening  capsules  and  dissolving  tablets  with    dispersed    microgranules  into  food  or  water  requires  that  the  granules  must  NOT    be  crushed  or  chewed  for  effect.  

1. Hospital  for  Sick  Children.  Drug  Handbook  and  Formulary.  2009.  

th
2. RX  Files  Drug  Comparison  Charts.  8  Edition  
3. ODB  Drug  Formulary  
4. eCPS,  2012  
Jew,  RK  et.  Al.  Extemporaneous  Formulations  for  Pediatric,  Geriatric,  and  Special  Needs  Patients.  ASHP.  2  Edition.  
nd
5.
6. Micromedex  .  Accessed  December  2012.  

Prepared  by  N  Fernandes  RPh,  Drug  Information  Centre,  HHS.  Reviewed  by  S  Yousaf  RPh,  Pediatrics  MCH.  

10/14 42
 3 PEDIATRIC FORMULARY NUTRIENTS PER 100 mL unless otherwise noted
May, 2012
FEED Kcal Protein Protein Fat Fat CHO CHO Na K Cl Ca PO4 Fe Vit A Vit D mOsm Indications for use
gram source gram gram (IU) (IU) / kg H20
source source mg mg mg mg mg mg
INFANT (0-1 YR)
HUMAN MILK * (mature) 70 1.1 Lactalbumin casein 4.2 Human milk fat 7.2 Lactose 18 1.4 1.1 0.7 0.5 0.05 61 - 290 Preferred feeding for term and preterm infants 70:30 whey:casein
70:30 -whey:casein
SIMILAC ADVANCE 68 1.4 Evaporated /dry skim 3.7 Safflower/sunflower 7.3 Lactose, 16 71 44 53 29 1.2 203 41 300 Iron fortified term infant formula with added DHA (5 mg) and
Abbott milk, whey protein coconut, soy monoglycerides ARA (13 mg)
ENFAMIL A+ 68 1.4 Modified milk 3.6 Palm olein, soy, 7.6 Lactose, corn syrup 18 73 43 53 29 1.22 200 41 300 Iron fortified term infant formula with added DHA (11.5 mg) and
Mead Johnson ingredients coconut, sunflower GOS maltodextrin ARA (23 mg). Prebiotics added (GOS, polydextrose)
polydextrose
GOODSTART 67 1.5 Whey hydrolysate 3.4 Palm olein, soy, 7.5 Lactose, corn 18 72 44 44 24 1.0 200 40 260 Hydrolyzed 100% whey-for infants at risk for milk protein allergy
Nestle (100% whey) coconut, safflower maltodextrins or mild reflux. ↓ PO4, DHA (10 mg) and ARA (20mg)
ENFAMIL A+ THICKENED 68 1.7 Nonfat milk 3.4 Palm olein, soy, 7.4 Rice starch lactose 27 73 51 53 36 1.2 200 41 230 Thickens when combines w/stomach acids- for reflux. Do not
Mead Johnson coconut, sunflower maltodextrin corn syrup concentrate beyond 24 kcal/oz. DHA (11.5mg) ARA (23mg)
ENFAMIL LACTOSE FREE 68 1.4 Milk protein isolates 3.6 Coconut, sunflower 7.4 Corn syrup solids 20 74 45 55 31 1.2 200 41 200 Milk-based, lactose free formula. NOT suitable for galactosemia.
Mead Johnson soy, palm olein maltodextrin RTF only in hospital – concentrate n/a.
ENFAMIL SOY A+ 68 1.7 Soy protein isolates 3.6 Coconut, sunflower 7.2 Corn syrup solids 24 81 54 71 47 1.22 200 41 170 Soy based formula. Suitable for vegans. DHA (11.5 mg) & ARA
Mead Johnson soy, palm olein Mono/diglycerides (23mg) Use powdered form only for galactosemia.
ALIMENTUM 68 1.9 Hydrolyzed casein 3.8 MCT, safflower, soy 6.9 Sucrose, mod tapioca 30 80 54 71 51 1.2 203 30 370 Hydrolyzed casein for milk protein allergy (60 % amino acids),
Abbott starch 33% MCT. Lactose-free. Not kosher. √ ODB
NUTRAMIGEN A+ 68 1.9 Hydrolyzed casein 3.6 Palm olein, soy, 7.0 Corn syrup solids, 32 74 58 64 35 1.22 200 34 320 rtf Hydrolyzed casein for milk protein allergy. Lactose/sucrose free.
Mead Johnson (100% casein) coconut, sunflower mod. corn starch 300 pdr
Not kosher. DHA (11.5 mg) & ARA (23mg) √ ODB
PREGESTIMIL A+ 68 1.9 Hydrolyzed casein 3.8 MCT, corn, soy, 6.9 Corn syrup solids, 32 74 58 64 35 1.22 240 34 330 Hydrolyzed casein for milk protein allergy/fat malabsorption. 55%
Mead Johnson (100% casein) sunflower/safflower mod. Cornstarch MCT. DHA(11.5 mg) & ARA(23mg) NO ODB
NEOCATE INFANT 67 2.1 Free amino acids 3 Safflower, coconut, 7.8 Corn syrup solids 25 104 52 83 62 1 212 35 375 Amino acid-based for milk protein allergy, malabsorption. 5%
Nutricia soy MCT ,95% LCT √ ODB
NUTRAMIGEN AA 68 1.9 Free amino acids 3.6 Palm olein, soy, 7.0 Corn syrup solids, 32 74 58 64 35 1.22 200 34 350 Amino acid based for severe cow milk protein/ multiple allergies.
Mead Johnson coconut, sunflower tapioca starch 2.8% MCT DHA (11.5 mg) & ARA (23mg) √ ODB
ENFAMIL ENFACARE A+ 74 2.1 Nonfat milk, whey 3.9 High oleic vegetable, 7.7 Lactose cornu syrup 28 78 58 89 49 1.34 330 52 310 Preterm discharge formula with more kcal, protein, vitamins,
protein soy, coconut, MCT solids minerals. DHA (12.6 mg) ARA (25 mg) 20% MCT √ ODB
Mead Johnson
ENFAMIL PREMATURE A+ 81 2.4 Non-fat milk 4.1 MCT, soy, high oleic 8.9 Corn syrup solids, 47 80 73 134 67 1.46 1010 195 300 For preterm Infants when human milk not available. 40% MCT.
With iron 24 kcal Mead Johnson Whey protein sunflower/safflower lactose DHA (13.8 mg) ARA (28mg)
ENFAMIL HMF Mead Johnson 14 1.1 Milk protein isolate, 1.0 MCT, soy <0.4 Corn syrup solids, 16 29 13 90 50 1.44 950 150 35 To fortify human milk fed to premature/low birthweight infants
(per 4 pkg HMF ) whey hydrolysate lactose MCT 70%
PEDIATRICS (1-10 YR)
PEDIASURE 100 3.0 Na caseinate (82%), 5 Safflower, soy MCT, 11 Maltodextrin, sucrose 37 130 101 97 80 1.4 259 32 310 Sole source of nutrition or supplement, oral/tube feed. Gluten and
Abbott whey protein (18%) sunflower lactose free . 20% MCT. √ ODB
PEDIASURE PLUS with fibre 150 4.2 Na/ca caseinate (82%) 7.5 Safflower, soy, MCT, 18 Maltodextrin, soy, FOS 65 180 122 90 80 1.4 330 45 345 High calorie Oral/tube feed. Not gluten free. 20% MCT, 0.75g
Abbott whey protein (18%) sunflower sucrose, oat hulls, fiber/100mL FOS = 0.35g/100 ml) √ ODB
NUTREN JR 100 3 Casein (50%), whey 5 Soy, canola, MCT 11 Maltodextrin, sucrose 46 132 108 120 84 1.4 332 60 350 Sole source nutrition or supplement. Oral/tube feed.
Nestle protein (50%) 21% MCT Lactose & gluten free √ ODB
NUTREN JR + Fiber 100 3 Isolated casein (50%) 5 Soy, canola, MCT 11 Maltodextrin, sucrose, 46 132 108 120 84 1.4 332 60 350 Supplement/tube feed. 21% MCT Lactose and gluten free. 0.36g
Nestle whey protein (50%) FOS/ inulin, pea fibre pea fiber and 0.2g FOS/inulin per 100 mL. √ ODB
PEPTAMEN JR 100 3 Hydrolyzed whey 3.8 MCT, soy, canola 14 Maltodextrin, sugar, 48 132 108 112 84 1.4 332 60 380 Partially hydrolyzed protein. 60% MCT, 100% whey peptides
Nestle corn starch √ ODB
PEPTAMEN JR 1.5 (prebio) 150 4.5 Hydrolyzed whey 6.8 MCT, soy, canola, 18 Maltodextrin, corn 73 198 162 165 135 2.1 48 80 450 Partially hydrolyzed protein, hypercaloric, Per 100mL- 14mg EPA
Nestle refined tuna oil starch, oligofructose +58mg DHA, 0.56 g Prebio Contains inulin 60% MCT NO ODB
NEOCATE JR (unflavoured) 100 3.3 Free amino acids 5 Coconut, 10.4 Corn syrup solids 41 137 63 113 70 1.5 250 44 590 Amino acid formula for allergy, protein intolerance,
Nutricia canola,safflower malabsorption. Fruit/choc flavours avail. 35% MCT √ ODB
COMPLEAT PEDIATRIC 100 3.8 Chicken/peas/gr bean 3.9 Canola, MCT 13 Cranberry juice corn 80 164 56 144 100 1.4 332 60 380 Made with pureed food/juice for1-13 yrs. 20% MCT per 100 mL -
Nestle Na caseinate syrup solids peaches 0.68 fibre from veg/fruit + guar gum fibre √ ODB
10/14 43
 PEDIATRIC FORMULARY NUTRIENTS PER 100 mL unless otherwise noted
May 2012
FEED Kcal Protein Protein Fat Fat CHO CHO Na K Cl Ca PO4 Fe Vit A Vit D mOsm Indications for use
gram source gram gram (IU) (IU) / kg H20
source source mg mg mg mg mg mg
PEDIATRICS (10+ yr)
HOMOGENIZED MILK 62 3.3 Casein, whey 3.4 Cow milk fat 4.7 Lactose 50 156 105 123 96 0.05 128 43 For children >1 yr if consuming balanced, varied diet with
adequate source of iron.
JEVITY 1 CAL 106 4.4 Na/Ca caseinate, soy 3.6 Safflower/sunflower 15.2 Maltodextrin, corn 74 124 115 91 76 1.4 381 31 310 Isotonic, high protein for tube feeding 1.4 g/100 mL fibre. √ ODB.
Abbott canola MCT syrup solids soy fibre 19% MCT
JEVITY 1.2 CAL 120 5.55 Na/ ca caseinate 3.9 Safflower, canola, 17.3 Maltodextrin FOS soy + 135 185 150 120 120 1.8 400 30 450 High kcal, high protein fiber containing tube feed. 1.2 g fiber /100
Soy protein oat fibre, corn syrup solids
Abbott MCT mL-soluble & insoluble.FOS = 1.0 g/100 mL. 19% MCT √ ODB
JEVITY 1.5 CAL 150 6.4 Na , ca caseinate, soy 5.0 MCT, canola, corn 21.6 Maltodextrin FOS soy + 140 215 136 120 120 1.8 375 40 525 High pro& kcal for fluid restriction/elevated energy needs 19%
Abbott oat fibre, corn syrup solids
MCT. 0.89g fiber/1g FOS/100 mL. √ ODB 1 & 1.5L size only
RESOURCE 2.0 200 8.0 Na + ca caseinate 9.0 Canola 22 Corn syrup, sugar, 80 150 120 106 106 2.0 529 42 790 High nitrogen, calorically dense.for fluid restriction. Oral
Nestle maltodextrin supplement / tube feed. √ ODB
ENSURE 106 4.0 Milk & soy protein 2.9 Soy, canola, corn 16 Sugar, corn 106 160 106 128 117 1.6 532 26 642 Oral supplement/ tube feed. Lactose & gluten free. Vanilla,
Abbott concentrates oils. Soy lecithin maltodextrin strawb, choc. NOT ODB covered (Ensure w fiber IS √ ODB)
ENSURE PLUS 151 5.7 Milk/ soy/ whey 4.7 Canola, corn oil. Soy 21.5 Corn maltodextrin, 106 170 115 128 117 1.6 532 26 633 Oral supp. Calorically dense, high pro for fluid restrictions.
Abbott protein concentrates lecithin sucrose vanilla Lactose/gluten free. Strawb/van/butter pecan. No fiber √ ODB
ENSURE HP 96 5.0 Na/ ca caseinate, 2.6 Safflower, canola, 13.2 Sugar, corn 123 182 107 117 117 1.5 496 21 546 High protein supplement/ tube feed. Lactose and gluten free. NOT
Abbott soy protein corn oils maltodextrin ODB covered. Van/choc/straw. No fiber
ISOSOURCE VHN 100 6.2 Na , ca caseinate 2.9 Canola, MCT, soy 12.8 Maltodextrin, guar gum 128 160 136 80 80 1.4 288 27 300 High protein, fibre containing tube feed. 50% of fat as MCT.
Nestle soy polysaccharides 0.45g fiber/100 mL. Lactose and gluten free √ ODB
OXEPA 150 6.3 Na, ca caseinates 9.4 Canola, MCT, 10.5 Sucrose, 131 196 169 106 106 2 1191 42.5 535 Low CHO, calorically dense - for critically ill/Sepsis/ARDS.
Abbott marine + borage oils maltodextrin EPA&GLA oil, 25% MCT. Lactose/gluten free. NOT kosher
OPTIMENTAL 100 5.1 Whey /na caseinate 2.8 Marine oils, MCT, 14 Maltodextrin, 112 171 120 106 106 1.3 823 28 585 Elemental for malabsorption EPA(2.3 g/L) DHA(1g/L) Arginine
Ross hydrolysates, canola, soy oils sucrose, FOS 3.6g/L. FOS 5g/L 60% fat as marine/MCT √ ODB NOT kosher
arginine
PERATIVE ** 130 6.7 Na caseinate, 3.74 Canola, MCT, corn 17.7 Maltodexrtrin 104 173 165 87 87 1.6 868 35 385 Peptide based for metabolically stressed. 8.05g/L arginine, Oral
Abbott arginine lactalbumin and tube feed. For those > 4yrs.
PEPTAMEN 100 4.0 Hydrolyzed whey 3.9 soybean, MCT 13 Maltodextrin, sugar 56 150 100 80 70 1.8 324 27 380 Elemental diet for impaired GI function/malabsorption. Oral &
Nestle corn starch tube. 100% whey protein. 70% MCT. Vanilla flavour √ ODB
PEPTAMEN 1.5 150 6.8 Whey 5.6 soybean, MCT 19 Maltodextrin, corn 102 186 174 100 100 2.7 486 41 550 Elemental high calorie diet for malabsorption. 100% whey protein.
Nestle starch Vanilla flavour 70% MCT. √ ODB
VITAL HN ** 100 4.2 Partially hydrolyzed 1.1 Safflower, MCT 18.5 Maltodextrin, sucrose 57 140 103 67 67 1.2 333 27 500 Peptide based, VERY low fat formula for limited digestion +
Abbott protein blend, whey absorption. Contains peptides and free aa. 43% MCT NOT kosher
VIVONEX PEDIATRIC 411 12.3 Free amino acids 12.1 Coconut, soybean 64.7 Maltodextrin, corn 205 616 534 493 411 5.34 127 164 360 Elemental formula for fat malabsorption-68% MCT - 1 pkg powder
(Per 100 g powder) Nestle palm/coconut starch (48.7g) + 220 mL water = 250 mL (0.8 kcal/mL) √ ODB
NEPRO CARB STEADY 180 8.1 Milk protein, Ca, mg, 9.6 Safflower, soy 16 Corn syrup solid FOS 106 106 84 106 72 1.9 318 8.5 745 Acute or chronic renal failure requiring dialysis. Oral/tube feed.
Abbott na caseinates lecithin, canola maltodextrin sucrose 0.84g FOS + 0.42g fiber per 100 mL NOT ODB Vanilla
SUPLENA 200 3.0 Na + ca caseinate 9.6 Safflower, soy 25 Maltodextrin, sucrose 78 112 93 139 74 1.9 106 8.5 600 Low protein for chronic/acute renal failure patient not on dialysis.
Abbott Oral/ tube feed. √ ODB
MODULEN IBD ** 99 3.5 Casein 4.8 Milk fat, MCT, corn 10.8 Corn syrup, sugar 35 126 80 83 54 0.96 284 38 340 Polymeric formula for Crohn’s disease. Oral/tube feed. Can be
Nestle concentrated to 1.5 kcal/mL. 25% MCT √ ODB

* Jensen, RD (ed) Handbook of Milk Composition. San Diego, Academic Press, 1995. ** HMF = Human Milk Fortifier
CONVERSION FACTORS: Ca - 40mg per mmol PO4 – 31mg per mmol Na – 23mg per mmol Cl – 35.5 mg per mmol K – 39 mg per mmol √ ODB indicates product covered by Ontario Drug Benefits
Vitamin A – 3.33 IU = 1 mcg Vitamin D – 40 IU = 1 mcg
** Available as non-formulary request

10/14 44
 PEDIATRIC FORMULARY NUTRIENTS PER 100 mL unless otherwise noted
May, 2012
FEED Kcal Protein Protein Fat Fat CHO CHO Na K Cl Ca PO4 Fe Vit A Vit D mOsm Indications for use
/ kg
grams source grams source gram source mg mg mg mg mg mg (IU) (IU) H 20
METABOLICS/SPECIALTY
PORTAGEN 470 17 Na caseinates 22 MCT, corn, coconut 54 Corn syrup solids 235 590 404 440 330 8.8 1560 130 n/a Fat malabsorption, chylothorax, defective lymphatic transport.
(per 100g powder) Mead Johnson (100%) Sugar 87% MCT Consult RD for recipe √ ODB
RCF (per 100mL concentrate) 81 4 Soy protein 7.2 soy, coconut, .008 - 59 146 83 140 100 2.4 405 81 - Carbohydrate-free soy formula for carbohydrate intolerance -
Abbott isolates safflower water and CHO source required. √ ODB
PROPHREE 510 0 28 Safflower, coconut, 65 Corn syrup solids 250 874 350 750 525 11.9 2000 300 - For reduced protein diet, specific amino acid disorders, or
(per 100g powder) Abbott soy increased energy, minerals, vitamins. 1 cup powder = 120 g
KETOCAL 720 15 Dry whole milk 72 Soy oils, soy 3 Corn syrup solids 300 1080 500 800 650 11 1500 208 Used in treatment of intractable epilepsy with ketogenic diet
(per 100g powder) Nutricia lecithin Contains aspartame. √ ODB
TYREX 1 480 15 L-amino acids 21.7 Safflower, coconut, 53 Corn syrup solids 190 675 325 575 400 9 1400 300 For infants with tyrosinemia. No PHE or TYR–must be from
(per 100 g powder) Abbott soy diet.1 cup powder = 120 grams; 2.73 mosm/g powder.
PHENEX 1 480 15 L-amino acids 21.7 Safflower, coconut, 53 Corn syrup solids 190 675 325 575 400 9 1400 300 For infants with phenylketonuria. No PHE – must be obtained
(per 100 g powder) Abbott soy from diet 1 cup powder = 120 grams; 2.72 mosm/g powder.
PROPIMEX 1 480 15 L-amino acids 21.7 Safflower, coconut, 53 Corn syrup solids 190 675 410 575 400 9 1400 300 For propionic academia/methylmalonic academia. No VAL,
(per 100 g powder) Abbott soy MET, low THR, ILE 1 cup powder =120 grams; 2.76 mosm/g
CYCLINEX 1 510 7.5 L-amino acids 24.6 Safflower, coconut, 57 Corn syrup solids 215 760 390 650 455 10 1600 300 For urea cycle disorders. Additional protein obtained from
(per 100 g powder) Abbott soy diet. 1 cup powder = 120 grams; 2.20 mosm/g powder.
GLUTAREX 1 480 15 L-amino acids 21.7 Safflower, coconut 53 Corn syrup solids 190 675 325 575 400 9 1400 300 For infants/children with glutaric aciduria Type 1or 2-
(per 100 g powder) Abbott sou Ketoadipic Aciduria. 1 cup powder = 120g 2.73 mosm/g pwdr.
CALCILO XD 513 11.4 Whey, sodium 28.7 Coconut, corn oil 52.3 Corn syrup 125 420 292 <50 128 9.2 1540 0 202 Low calcium, low phosphorus NO vit D formula with iron for
(per 100 g powder) Abbott caseinate hypercalcemia. Order via Specialty Food Shop. 1 cup = 105 g
MODULARS/SUPPLEMENTS
PEDIASURE COMPLETE 235 9.3 Milk protein, 7.7 Soy,canola, MCT, 33 Sucrose, FOS (1g), 90 450 204 250 250 2.4 782 24 600 Supplement-not for tube feeds. Chocolate/vanilla (only choc in
(Per 235 mL bottle) Abbott whey, soy coconut/palm maltodextrin hospital) DHA(10 mg) ARA(3.3) 15% MCT NO ODB
POLYCOSE POWDER 380 - - 0 - 94 Glucose polymers 130 10 223 30 15 0.09 - - - Carbohydrate module, lactose free 1 Cup = 100g √ ODB
(per 100 gram) Abbott
MICROLIPID 4.5 - - 0.5 Safflower, soy lecithin - - - - - - - - - - - Fat module 1 TBSP = 67.5 kcal NOT ODB covered
(per mL) Nestle
MCT OIL 7.7 - - MCT - - - - - - - - - - - Fat module for fat malabsorption, cholestasis. 1 TBSP = 14 g
(per mL) Nestle = 115 kcal √ ODB
RESOURCE BENEPROTEIN 3.6 0.86 Whey (100%) 0 - 0 - 1.4 5 - 4.3 2.1 - - - Protein module lactose/gluten free. 1 pkg = 7g = 6g pro/25kcal
(per gram) Nestle Mix 1 pkg in 60-120 ml water for tube feed, 30 mosm/pkg
BREAKFAST ANYTIME 300 15 Skim milk, milk 9 Corn oil, milk fat 41 Maltodextrin, sugar 250 370 - 420 370 7 1998 - - Oral supplement, 315 mL tetra pack, chocolate, vanilla,
Nestle (per 315 mL box) protein lactose, inulin strawberry. 4 g FOS/inulin per 315 mL serving NO ODB
BOOST FRUIT BEVERAGE 77 3.7 Whey (100%) 0.2 soy 15 Sugar, corn syrup 1.3 0.1 2.6 1.4 2.2 1.0 80 0.5 700 Low fat supplement. Lactose, gluten free. Orange, peach,
Nestle solids wildberry. √ ODB
DUOCAL 492 0 - 22.3 Corn, coconut, palm 73 Mono/diglycerides <20 <5 <20 <5 <5 - - - 310 Soluble fat and CHO module. Lactose, gluten, sucrose fructose
(per 100 gram) Nutricia kernel hydrolyzed cornstarch free. 35% of fat as MCT. Oral/tube 1tbsp = 42kcal NO ODB
OTHER PRODUCTS
GLUTAMINE powder 40 ?? L-glutamine 0 ?? - - - - - - - - - Dosage = 0.5 g/kg divided TID. Mix 10g in liquid (not
Per 10g container pop)/add to 60mL for tube feed. Not with renal/liver disease
RESOURCE THICKEN UP 15 4 Modified food 10 Instant food thickener for dysphagia management.
Nestle (per 1 Tbsp or 4.5g) starch (corn)
ENFAMIL ENFALYTE 12.6 3.2 Corn syrup solids, 115 98 160 170 Oral electrolyte maintenance solution. Light cherry flavour,
Mead Johnson citrates
PEDIALYTE (per 100 mL) 10 - - - - 2.5 Dextrose 104 78 124 - - - - - 250 Oral electrolyte maintenance solution
Abbott
PEDIALYTE POPSICLES 6.3 - - - - 1.6 Dextrose 64 51 78 - - - - - 250 Oral electrolyte maintenance. Popsicles contain flavour +
per 62.5 mL popsicle - Abbott colouring. Melt and add to regular pedialyte for flavour.
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