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Pocket Guide For
ANTIMICROBIAL DOSING
IN RENAL FAILURE
For
the
use
only
of
a R
egis
tere
d M
edic
al P
ract
ition
er o
r a
Hos
pita
l or
a La
bora
tory
.
Cefoperazone / Sulbactam IV / IM Injection 1.5g & 3g
Medicine is an ever-changing science.
This book is based on sources believed to be reliable in
providing information that is complete and generally in
accordance with standards accepted at the time of
publication.
Every effort has been made to ensure that the drug doses
and other information are presented accurately in this
publication.
However, the ultimate responsibility rests solely with the
prescribing physician.
PREFACE
suffering from renal insufficiency.
T
INDEX
ANTIBACTERIALS 7
1. Beta-lactam Class
2. Aminoglycosides
3. Polymyxins
4. Fluoroquinolones
5. Glycopeptides
6. Macrolides
7. Tetracyclines / Glycylcycline
8. Nitroimidazole
9. Oxazolidinones
10. Lincosamide
ANTIFUNGALS 22
11. Polyenes
12. Azoles
13. Echinocandins
ANTIVIRALS 26
INTRODUCTION 4
261 2
INTRODUCTION
In renally challenged individuals, the drug tends to be in the system for a longer period as compared to those with normal renal function hence dose adjustments are essential to avoid drug toxicity to compensate for the decreased clearance of the drug.
A number of clinical laboratory tests like creatinine clearance test, urea clearance test, urine osmolality
*test, urine protein test and BUN test are used to determine the cause and extent of kidney dysfunction.
Amongst these tests creatinine clearance test and creatinine test are more widely accepted by the clinicians.
Creatinine is a waste product of muscle energy metabolism which is produced at a constant rate that is proportional to the individual's muscle mass. Because the body does not recycle it, all creatinine filtered by the kidneys in a given amount of time is excreted in the urine, making creatinine clearance a very specific measurement of kidney function.
Creatinine clearance test. This test evaluates how efficiently the kidneys clear creatinine from the blood. Low clearance values for creatinine indicate a diminished ability of the kidneys to filter waste
* BUN-Blood Urea Nitrogen test263 4
products from the blood and excrete them in the urine.
For a 24-hour urine collection, normal results are 90 mL/min–139 mL/min for adult males younger than 40 years and 80–125 mL/min for adult females younger than 40 years. For people over 40 years, values decrease by 6.5 mL/min for each decade of life.
Creatinine test. This test measures blood levels of creatinine. An elevated blood creatinine level is a more sensitive indicator of impaired kidney function than the BUN. Creatinine should be 0.8–1.2 mg/dL for males, and 0.6–0.9 mg/dL for females.
DRUG DOSE ADJUSTMENT IN RENAL PATIENTS
Serum creatinine is used to estimate Glomerular Filtration Rate (GFR) in order to supply appropriate doses to renally insufficient patients. GFR is related directly to the urine creatinine excretion and inversely related to serum creatinine.
When creatinine clearance is unavailable, it can be calculated by using Cockcroft – Gault formula as mentioned below:
Creatinine
clearance (mL/min)
=(140-age) x lean body weight (kg)
Plasma creatinine (mg/dL) x 72
(In case of female patients this value should be multiplied by 0.85 since a lower fraction of the body weight is composed of muscle)
However, the clinician's decision should also be supported by the patient's clinical condition, diet, age, gender, weight and other parameters while dosing renally compromised patients.
265 6
ANTIBACTERIALS
BETA-LACTAM CLASSBETA-LACTAM CLASS
*HD-Hemodialysis
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
PENICILLINS
>40 No dose adjustment necessary
20-40 Serious systemic infections: 4g q8h
<20
*cUTI: 3g q8h
Serious systemic infections: 4g q8h
2g q8h, 1g additional dose after each dialysis
*HD
Uncomplicated & cUTI: 3g q12hPiperacillin3-4g q4h -6h
as 20-30 min
infusion
Ticarcillin
3g q4h
as 30 min
infusion
>60
30-60
10-30
<10
No dose adjustment necessary
2g q4h
2g q8h
2g q12h
<10 with hepatic
dysfunction2g q24h
Peritoneal dialysis
3g q12h
HD2g q12h supplemented
with 3g after each dialysis
267 8
1
*cUTI-Complicated Urinary Tract Infection
BETA-LACTAM CLASSBETA-LACTAM CLASS
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
BETA-LACTAM CLASSBETA-LACTAM CLASS
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
PENICILLINS
>50-90
10-50
No dose adjustment necessary
250mg-2g q6-12h
<10
HD
250mg-2g q12-24h
Dose after dialysis
Ampicillin 250mg-2g q6h
CEPHALOSPORINS
Cefuroxime Sodium
Usual dose:750 mg -1.5 g q8h
Life threatening infections: 1.5g q6h
Meningitis:Maximum dose 3g q8h
>20
10-20
<10
HD
750mg -1.5 g q 8h
750mg q12h
750mg q24h
Further dose after dialysis
*CAPD 250mg q12h
*CAPD-Continuous Ambulatory Peritoneal Dialysis
Ceftriaxone Sodium
1-2g q24h in equally two divided dosesas 30 min infusion
Max dose : 4g
-
No dose adjustment necessary but serum monitoring is required in severe renal impairment and in patients with both renal and
hepatic dysfunction.
Ceftazidime
Usual dose:1g q8-12h
Serious infections:2g q8-12h
Loading dose : 1g
50-31
30-16
15-6
< 5
CAPD
1g q12h
1g q24h
500mg q24h
500mg q48h
500mg q24h
CEPHALOSPORINS
Cefotaxime 2g q12h
>50-90
10-50
<10
HD
CAPD
2 g q8-12h
2 g q12-24h
2g q24h
1g extra after dialysis
0.5-1g q24h
Cefoperazone
2-4g q12h(Maximum
dose)
12g q24h
Mild to
severe
No dose adjustment necessary when usual doses are administered,
serum monitoring required when high doses are administered
HD with hepatic
dysfunctionMax 1-2g/day
Cefepime
1-2g q12h(Maximum
dose)
Febrile Neutropenia
2g q8h
>50-90
10-50
<10
HD
CAPD
2g q8h
2g q12-24h
1g q24h
1g extra after dialysis
1-2g q48h
Cefpirome 1-2g q12h
Loading dose : 1-2g*
50-20
20-5
<5 (HD patients)
*Depending on the severity of infection
0.5-1g q12h
0.5-1g q24h
1.0g daily +0.5g immediately after dialysis
269 10
BETA-LACTAM CLASSBETA-LACTAM CLASS
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
BETA-LACTAM CLASSBETA-LACTAM CLASS
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
MONOBACTAMS
Aztreonam 1-2g q6-8h
10-30
<10
Normal dose followed by half of the initial dose
Normal dose followed by one quarter of the initial dose
Ertapenem
³13yrs
1g q24h as
30min infusion
(for cIAIs, cSSTIs,
CAP,cUTI)
>30
£ 30 - £ 10
HD500mg within 6h from HD
followed by 150mg after HD or500mg 6h prior to HD
CARBAPENEMS
Meropenem
(MEROCRIT)
0.5-1g q8h
Meningitis:2g q8h
as 15-30min infusion
26-50
10-25
<10
HD
1g q12h
0.5g q12h
0.5g q24h
At the completion of haemodialysis
Imipenem/
Cilastatin
(IMICRIT)
0.25-1g q6-8h
as 40 -60 min
infusion
31-70
21-30
6-20
0.5g q6-8h
0.5g 8-12h
0.25g q12h
£ 5Not recommended unless
HD is started within 48 hours.
<5 and
undergoing
HD
0.25g, but only after HD and at 12h interval
Doripenem
(18yrs and
above)
0.5g q8h as 1h infusion
(for cIAIs, cUTIs including pyelonephritis)
>50
CARBAPENEMS
Dialysis patients with CNS disease should receive Imipenem/Cilastatin
only when the benefit outweighs the potential risk of convulsions
No dose adjustment necessary
0.5g q24h
No dose adjustment necessary
BETA-LACTAM/BETA-LACTAMASE INHIBITORS
Amoxicillin/
Clavulanic acid
(ADVENT)
1.2g q6-8h
>30 No dose adjustment necessary
<10
1.2g IV stat., followed by 600mg q24h
An additional 600mg IV dose may need to be given during
dialysis and at the end of dialysis.
Ampicillin/
Sulbactam
(2:1)
1.5 - 3g q6h
>30
Piperacillin/
Tazobactam
(TAZACT)
Nosocomial pneumonia:
4.5g q6h plus an
aminoglycoside
Other Infections:3.375g q6has 30 min infusion
>40
20-40
<20
HD
CAPD
3.375g q6h & for nosocomial pneumonia 4.5g q6h
2.25g q6h & for nosocomial pneumonia 3.375g q6h
2.25g q8h & for nosocomial pneumonia 2.25g q6h
2.25g q12h & for nosocomial pneumonia 2.25g q8h
2.25g q12h & for nosocomial pneumonia 2.25g q8h
30 – 50
10-30
HD
0.25g q8h
Insufficient data
0.25g q12h
10-30 1.2g IV stat., followed by 600mg q12h
1.5 - 3g q6-8h
1.5 - 3g q12h
1.5 - 3g q24h
15-29
5-14
2611 12
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
BETA-LACTAM CLASSBETA-LACTAM CLASS
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
Cefoperazone/
Sulbactam
(2:1, VIATRAN)
BETA-LACTAM/BETA-LACTAMASE INHIBITORS
3.0-4.5g q12has 15-60 min infusion
(Maximum recommended dose
of cefoperazone is 8g & sulbactam is 4g)
15-30
<15
HD
3g q12h
1.5g q12h
Dose to be given after dialysis
Cefepime/Tazobactam
Recommended Maintenance Schedule
>60
30-60
11-29
<11
CAPD
HD
500mg q12h
1g q12h
2g q12h
2g q8h
500mg q24h
1g q24h
2g q24h
2g q12h
500mg q24h
500mg q24h
1g q24h
2g q24h
250mg q24h
250mg q24h
500mg q24h
1g q24h
500mg q48h
1g q48h
2g q48h
2g q48h
1g on day 1, then 500mg q24h after dialysis
1g q24h
On haemodialysis days, administer following haemodialysis.
Whenever possible administer at the same time each day
Uncomplicated / complicated UTI
(including pyelonephritis)
Mild to moderate: 500mg or 1000mg
IV/IM q12h.
Severe 2000mg IV q12h.
Moderate to severe Uncomplicated SSIs
2000mg IV q12h.
Complicated IAIs (used in combination with metronidazole): 2000mg IV q12h
Amikacin
7.5 mg/kg/day q12h(Equivalent to 500 mg
q12h in adults).
Pseudomonal Infections: 500mg (Should never
exceed 1.5 g/day, therapy not to exceed
10 days as 30 min infusion)
>50-90
10-50
<10
HD
No dose adjustment necessary
7.5mg/kg/day q24h
7.5mg/kg/day q48h
Half of normal renal function
dose afterdialysis
Gentamicin(40 mg/mL)
Systemic and urinary
tract infections3 mg/kg/day up to
80mg q8h
Life threatening infections 5mg/kg/day
initially then 3mg/kg/day as soon as improvement
is indicated q6-8 has 20- 30 min infusion
The first dose should be as normal recommended
>70
35-70
24-34
16-23
10-15
5-9
80mg q8h
80mg q12h
80mg q18h
80mg q24h
80mg q36h
80mg q48h
Dosage in obese patients should be based on an estimate of lean body mass.
AMINOGLYCOSIDESAMINOGLYCOSIDES
2613 14Cefoperazone / Sulbactam
IV / IM Injection 1.5g & 3g
2
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
AMINOGLYCOSIDESAMINOGLYCOSIDES
Tobramycin(40 mg/mL)
Serious infections1mg/kg/day q8h
Life-threatening infections
5mg/kg/day may be administered
in three or four equal dosages.
The dosage should be reduced to
3mg/kg/day as soon as clinically
indicated. Dosage should not
exceed 5mg/kg/day, unless serum levels
are monitored in order to prevent
increased toxicity due to excessive blood levels as
20-60 min infusion
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
AMINOGLYCOSIDESAMINOGLYCOSIDES
Loading dose of 1mg/kg, for life-threatening infections,
dosages 50% above those normally recommended may be used.
The dosages should be reduced as soon as possible when
improvement is noted.
Weight
50-60 kg 60 – 80 kg
>70 80mg q8h60mg q8h
69 – 40 60mg q12h 80mg q12h
39 – 20
19 – 10
9 – 5
< 4
60mg q18h 80mg q18h
60mg q24h 80mg q24h
60mg q36h 80mg q36h
60mg q48h When dialysis
is not being performed.
80mg q48h When dialysis
is not being performed
Dosage in obese patients should be based on an estimate of lean body mass.
Netilmicin
4–6mg/kg/day(150mg q12h
or100mg q8h
or300mg q24h)
Dosage in obese patients should be based on an estimate of lean body mass.
Dosage at 8-hour intervals after the usual initial dose
No dose adjustment necessary
80 % of usual dose
65 % of usual dose
55 % of usual dose
50 % of usual dose
40 % of usual dose
35 % of usual dose
30 % of usual dose
25 % of usual dose
20 % of usual dose
15 % of usual dose
10 % of usual dose
>100
70–100
55-70
45-55
40-45
35-40
30-35
25-30
20-25
15-20
10-15
<10
2615 16
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
POLYMYXINSPOLYMYXINS
Colistimethate Sodium IV
(XYLISTIN)
Upto 60kg
50,000-75,000
units/kg/day
Above 60kg
1-2MIU q8h
as 30 min
infusion
20-50 1-2 MIU q8h
10-20 1MIU q12-18h
Polymixin B15,000 - 25,000
units/kg/day
1 MIU q18-24h<10
20-50
5-20
<5
75% to 100% of the
normal daily dose given in
divided doses q12 h
50% of normal daily dose
given in divided doses q12 h
15% of normal daily dose
given in divided doses q12h
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
FLUOROQUINOLONESFLUOROQUINOLONES
Ciprofloxacin
400mg q8-12h
depending on the
severity of infection
as 1h infusion
>30
5-29
No dose adjustment required
200-400mg q18-24h
Levofloxacin
250-500mg q24h
as 1h infusion
or
750mg q24h
as 90min infusion
20-49750mg q48h OR 500mg initial
dose, followed by 250mg q24h
10-19
750mg initial dose, then 500mg
q48h or 500mg initial dose, then
250mg q48h or 250mg q48h
(uncomplicated UTI,
no dosage adjustment required)
HD/CAPD
750mg initial dose, then
500 mg q48h or 500mg
initial dose, then 250 mg q48h
Moxifloxacin
(IV/ Oral)
18yrs and above
400mg q24h-
No dose adjustment required
including for those on HD/CAPD
Gemifloxacin
(Oral)320mg q24h
>40
£ 40
No dose adjustment required
160mg q24h
Prulifloxacin
(Oral)600mg q24h
Sufficient
data lacking-
Pazufloxacin
500mg q12h over 30 min to 1hr infusion Dose can be reduced to 300mg q12h based on age and symptoms
44.7
13.6
Dialysis
300mg q12h
300mg q24h
300mg once every 3 days
2617 18
3
4
Colistimethate sodium 1 MIU & 2 MIU Injection, Infusion or Inhalation
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
GLYCOPEPTIDESGLYCOPEPTIDES
*GIT-Gastrointestinal Tract
Vancomycin IV
(VANLID IV)
500mg q6h
or 1g q12h
as 1h infusion
>50-90
10-50
<10/HD/CAPD
1g q12h
1g q24-96h
1g q4-7days
Vancomycin Oral
(VANLID
Capsules)
0.5-2g in 3-4
divided doses.
Poor
absorption *through GIT
No dose
adjustment required
Teicoplanin (TICOCIN)
Moderate Infections:
(SSTIs, UTIs, LRTIs)
Loading dose:
400mg q24h
Maintenance dose:
200mg q24h
Severe Infections:
(B&J, sepsis,
endocarditis)
Loading dose:
Three 400mg
injections &
administered
12h apart.
Maintenance dose:
400mg q24h
No dose adjustment till 4th day, after 4th day
40-60 Half of normal dose q24h
<40 One third of normal dose q24h
HD
One third of normal dose q24h. Teicoplanin is not removed
by dialysis.
CAPD
After a single loading IV dose of 400mg if the patient is febrile, the recommended
dosage is 20mg/L per bag in the first week, 20mg/L in
alternate bags in the second week and 20mg/L in the overnight dwell bag only
during the third week.
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
MACROLIDESMACROLIDES
Clarithromycin I.V500mg q12h
as 60 min infusion<30 Half of normal dose
Azithromycin
500mg q24h for
first two days
followed by
500mg oral dose
-No dose adjustment required,
however caution must be exercised
in severe renal insufficiencies
<10 Administer with caution
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
TETRACYCLINES / GLYCYLCYCLINETETRACYCLINES / GLYCYLCYCLINE
Tigecycline
Initial dose of
100mg followed by
q12h as 30-60 min
infusion.
Mild,
moderate,
severe & HD
No dose adjustment required
NITROIMIDAZOLENITROIMIDAZOLE
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
Metronidazole
Prophylaxis: 500mg
before surgery;
repeated 8 hourly
Treatment:
500mg q8-12h
Mild, moderate,
severe
HD
No dose adjustment required
Dose after dialysis
2619 20
5
6
7
8
ANTIFUNGALS
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
OXAZOLIDINONESOXAZOLIDINONES
Linezolid
(IV/Oral)
12yrs & older
600mg q12h-
No dose adjustment
required.
However, in severe renal
insufficiency should be
used with special caution
and only when the
anticipated benefit is
considered to outweigh
the theoretical risk.
LINCOSAMIDELINCOSAMIDE
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
Clindamycin IV
(DALCINEX)
600mg- 2.7 g
in 2-4 divided
doses as
30min infusion
-
No dose
adjustment
required
2621 22
9
10
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
POLYENESPOLYENES
Conventional
Amphotericin B0.3-1.5mg /kg
as 1-4h infusion
<10 q24-36h
HD
CAPD
no supplement
q24-36h
Liposomal
Amphotericin B
(PHOSOME)
3–5mg/kg
once daily.
For cryptococcal
meningitis in
HIV positive
individuals
6mg/kg OD
as 120 min
infusion
-
Disposition of
amphotericin B after
administration of
liposomal amphotericin
B has not been studied.
However, liposomal
amphotericin B has
been successfully
administered to patients
with pre-existing renal
impairment.
ANTIMICROBIALS
USUAL DOSE (Normal Renal
Function)
CrCl(ml/min)
DOSAGE ADJUSTMENT (In Renal Insufficiency)
Fluconazole
(FORCAN)
Loading dose:
100-800mg q12h
Maintenance dose:
50-800mg q24h
{Depending on
severity
of infection}
>50
11-50
Dialysis
No dose adjustment required
50% normal dose q24h
Normal dose after dialysis
Voriconazole
(VORITEK)
Loading dose:
6mg/kg q12h stfor 1 24hrs
Maintenance dose:
4mg/kg q12h
as 1-2h infusion
>50
<50
No dose adjustment required.
Accumulation of
vehicle occurs so switch to
oral formulation
AZOLESAZOLES
2623 24
11
12
ANTIVIRALS
ANTIMICROBIALSUSUAL DOSE
(Normal Renal Function)CrCl
(ml/min)DOSAGE ADJUSTMENT (In Renal Insufficiency)
ECHINOCANDINSECHINOCANDINS
* HSCT- Hematopoietic Stem Cell Transplant
Caspofungin
Loading dose: 70mg q24h
Maintenance dose:
50mg q24h as 1h infusion
-
No dose
adjustment
required
Anidulafungin -
No dose
adjustment
required
Micafungin
Candidemia & other
candidial infections:
Loading Dose: 200mg on day 1
Maintenance dose:
100mg daily dose
Esophageal candidiasis:
Loading Dose: 100mg on day 1
Maintenance dose:
50mg daily dose
A loading dose is not required. Infuse over 1 hour
Candidemia, Acute
Disseminated Candidiasis,
Candida Peritonitis and
Abscesses: 100mg q24h
Esophageal Candidiasis
150mg q24h
Prophylaxis of Candida * Infections in HSCT
Recipients 50mg q24h
-No dose
adjustment
required
2625 26
13
REFERENCES
Drugs Facts & Comparisons (2007 Edition) PiperacillinTicarcillinCaspofungin
The Sanford Guide to Antimicrobial Therapy 2009 (Thirty Ninth Edition) AmpicillinCefotaximeCefipimeVancomycinAmikacin
The electronic Medicines Compendium (eMC) http://emc.medicines.org.uk/ AztreonamImipenem CilastatinGentamicinTobramycinTigecyclineMetronidazoleFluconazoleVoriconazoleAcyclovirColistimethate sodiumClindamycinFluconazoleTeicoplanin
Indian J crit care Med Apr-Jun 2009,Vol 13,Issue 2.Polymixin B
Cefobid Pack Insert, June 2006,Pfizer:Cefeperazone
Unasyn Pack Insert, April 2007, PfizerAmpicillin/sulbactam
Eraxis Pack Insert, June 2009,Pfizer : Anidulafungin
Magnex Forte Pack Insert, 2009,Pfizer Cefoperazone Sulbactam
Factive Pack Insert, 2009, OscientGemifloxacin
Augmentin Pack Insert, 2009, Glaxo SmikthlineAmoxicillin clavulanic acid
Pasil Pack Insert, September 2005, Taisho Toyama Pharmaceutical Co., Ltd.Pazufloxacin
Drugs 2004; 64 (19): 2221-2234Prulifloxacin
Netromycin Pack Insert, 2009 Fulford IndiaNetilimicin
Physician's Desk Reference 2009 (PDR) Cefuroxime SodiumCeftriaxone SodiumCeftazidimeErtapenemMeropenemImipenem/CilastatinDoripenemLevofloxacinMoxifloxacinLinezolidLiposomal Amphotericin BPiperacillin /TazobactamMicafungin
Medsafe ( http://www.medsafe.govt.nz/ )CefpiromeClarithromycin
Drugs @ FDA (http://www.accessdata.fda.gov/Scripts/cder/DrugsatFDA/ )Cefipime
AHFS 2009 AzithromycinConventional Amphotericin BGanciclovir
Aciclovir
(ACIVIR)
Herpes simplex or
Varicella zoster infection:
5mg/kg q8h
Immunocompromised
patients with Varicella
zoster infection or
Herpes encephalitis:
10mg/kg q8h
Obese patients:
As per actual body weight
25-50
10-25
0-10
HD
5-10mg/kg IV q12h
Half of the above dose
immediately after dialysis
and thereafter q24h
5-10mg/kg IV q24h
Half of the above
dose q24h.
CMV Infections Initial induction therapy:
5 mg/kg every q12h for 14–21 days as 1h infusion.
Maintenance regimen:6 mg/kg once daily
5 days weekly.
Prevention of CMV in HIV-Infected Individuals
5–6 mg/kg once daily 5–7 days each week
Prevention of CMV in Transplant Recipients
5 mg/kg q12 h for 7–14 days
Ganciclovir
ANTIMICROBIALSUSUAL DOSE
(Normal Renal Function)CrCl
(ml/min)DOSAGE ADJUSTMENT (In Renal Insufficiency)
50–69 2.5 q12h
25–49 2.5q12h
10–24 1.25q24h
2627 28