Intramuscular administration, pediatric dosing

Pharmacokinetics Serum levels considered therapeutic (40pg/ml or greater) are achieved in most high-risk infants on intramuscular administration of the recommended dose. In studies in adult volunteers, palivizumab had a pharmacokinetic profile similar to a human IgGi antibody in regard to the volume of distribution and the half-life (mean 18 days). In pediatric patients less than 24 months of age, the mean half-life of palivizumab was 20 days. 

Adverse reactions include nystagmus, dizziness, and ataxia. Paresthesias and pruritus typically disappear within 5 to 10 minutes after the infusion. In adults, the rate of administration should be 100 to 150 mg PE/min. Pediatric patients should receive fosphenytoin at a rate of 1 to 3 mg PE/kg/min. Continuous ECG, blood pressure, and respiratory status monitoring is recommended for aU loading doses of fosphenytoin. Seram phenytoin concentrations should not be obtained for at least 2 hours after IV and 4 hours after intramuscular administration of fosphenytoin. 

In mass casualty situations, intravenous antidotes may not be available. In that case, the intramuscular administration is acceptable. Most Emergency Medical Systems in the United States now stock military Autoinjector units containing atropine and pralidoxime, although kits with pediatric doses may not be available. However, in critical situations, children older than 2 or 3 years of age weighing at least 13 kg might benefit from 2 mg of atropine and 600 mg pralidoxime administered intramuscularly with auto-injectors (7). Experience with the accidental atropine auto-injection in 240 Israeli children unexposed to nerve agents revealed that... 

G Schubiger, O Tonz, J Griiter, MJ Shearer. Vitamin K, concentration in breastfed neonates after oral or intramuscular administration of a single dose of a new mixed-miceUar preparation of phyUoquinone. J Pediatr Gastroenterol Nutr 16(4) 435 39, 1993. 

Since staphylococcal and streptococcal cellulitis are indistinguishable clinically," administration of a semisynthetic penicillin (nafcillin or oxacillin) is recommended until a definitive diagnosis, by skin or blood cultures, can be made " " (Table 108-3). Mild to moderate infections not associated with systemic symptoms may be treated orally with dicloxacillin. If documented to be a mild cellulitis secondary to streptococci, oral penicillin VK or intramuscular procaine penicillin may be administered. More severe infections, either staphylococcal or streptococcal, should be treated initially with intravenous antibiotic regimens. Ceftriaxone 50-100 mg/kg as a single daily dose is efficacious in the treatment of celluMs in pediatric patients. The usual duration of therapy for cellulitis is 7 to 10 days. " ... 

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