Use of QVAR with a spacer device in children less than 5 years of age is not recommended. In vitro dose characterization studies were performed with QVAR 40 mcg/actuation with the OptiChamber and AeroChamber Plus ® spacer utilizing inspiratory flows representative of children under 5 years old. These studies indicated that the amount of medication delivered through the spacing device decreased rapidly with increasing wait times of 5 to 10 seconds as shown in Table 2. If QVAR is used with a spacer device, it is important to inhale immediately.
5 mg/kg/dose IV every 36 to 48 hours or 4 mg/kg/dose IV every 24 hours. In one gentamicin protocol (which could be extrapolated to tobramycin), the usual dose of 4 mg/kg/dose IV every 24 hours was extended to 4 mg/kg/dose IV every 48 hours if there was concurrent indomethacin. An alternative dosing regimen based on gestational age (GA) is also used which is as follows: GA younger than 32 weeks: 4 mg/kg/dose IV every 48 hours; GA 32 to 36 weeks: 4 mg/kg/dose IV every 36 hours; GA 37 weeks and older: 4 mg/kg/dose IV every 24 hours.