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Myelomeningocele: Antibiotics

UTI prophylaxis if any hydronephrosis on renal US:

  • Amoxicillin 20 mg/kg/dose enterally once a day.
  • Cephalexin 20 mg/kg/day either once or divided twice a day.

If patient is NPO the IV equivalents are:

  • Ampicillin 50 mg/kg/dose IV once a day.
  • Cefazolin 25 mg/kg/dose IV once a day.

For the initial antibiotic treatment:

  • Ampicillin 100 mg/kg/dose q 8.
  • Gentamicin 4 mg/kg ( > 2 kg) q 24 hours; 3 mg/kg (< 2 kg) q 24 hours.

For shunt prophylaxis:

  • Gentamicin 4 mg/kg/dose IV q 24 hours (for patients > 2 kg).
  • Vancomycin:
    • ≥ 27 weeks gestation up to 43 weeks: 15 mg/kg/dose q 12 hours x 2 doses.
    • ≥ 43 weeks gestation: 15 mg/kg/dose q 8 hours x 3 doses.

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.