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Dosing information in renal impairment

No.

Drug name

Aminoglycoside antibiotics
1 Amikacin

2

Gentamicin

Usual dose

7.5 mg /kg q 12 hr

Adjustment for Renal failure estimated
CrCl (ml/min)

> 50-90
10-50
< 10
15 mg per kg Once Daily > 80
60-80
40-60
30-40
20-30
10-20
< 10
1.7 mg/kg q 8 hr
> 50-90
10-50
< 10
5.1 mg per kg Once Daily > 80
40-60
mg/kg/day
20-30
hr
< 10

7.5 mg/kg q 12 hr
7.5 mg/kg q 24 hr
7.5 mg/kg q 48 hr
15 mg/kg/day
12 mg/kg/day
7.5 mg/kg/day
4 mg/kg/day
7.5 mg/kg q 48 hr
4 mg/kg q 48 hr
3 mg/kg q 72 hr and AD
100% q 8 hr
100% q 12 - 24 hr
100% 48 hr
5.1 mg/kg/day , 60-80 4 mg/kg/day
3.5 mg/kg/day , 30-40 2.5

HD , CAPD

HD: ½ of normal renal function dose AD
CAPD : 15-20 mg lost per L dialysate
per day

HD: ½ of normal renal function dose AD
CAPD: 3-4 mg lost per L dialysate
per day

4 mg/kg q 48 hr,10-20 3mg/kg q 48
2 mg/kg q 72 hr and AD
1

70% q 12 hr 20 .30% q 24 .5 mg/ kg 8 .48 hr 15 mg/kg/day 12 mg/kg/day 7.7.5 mg/kg q 48 hr 4 mg/kg q 48 hr 3 mg/kg q 72 hr and AD 100% q 12 hr 60 .12 hr 30 .12 hr 50 .5 mg/kg/day 4 mg/kg/day 7. of 1.Dosing information in renal impairment 3 4 Streptomycin sulfate Kanamycin 15 mg/kg (max.5 mg/kg/day 4 mg/kg/day 7.80 15 mg per kg once daily 10-50 < 10 > 80 60-80 40-60 30-40 20-30 10-20 < 10 15 mg/kg q 24 hr 15 mg/kg q 24-72 hr 15 mg/kg q 72-96 hr 15 mg/kg/day 12 mg/kg/day 7.90% q 8 .0 g) q > 50-90 24 hr 10-50 < 10 15 mg per kg once daily > 80 60-80 40-60 30-40 20-30 10-20 < 10 5 .5 mg/kg q 48 hr 4 mg/kg q 48 hr 3 mg/kg q 72 hr or AD HD: CAPD: ½ of normal renal function dose AD 20-40 mg lost per L dialysate per day HD: Extra 50% of normal renal Function dose AD CAPD: 15-20 mg lost per L of Dialysate per day 2 .

0 100% normal dose q 8 hr 100% normal dose q 12-24 hr 100% normal dose q 48 hr 6.250 mg q 12 hr > 50-90 10-50 < 10 1 gm q 8 hr 1 gm q 12 hr same dose for CRRT 0.500 mg q 6 .5 mg/kg q 48 hr 2 mg/kg q 72 hr and AD HD: Extra 50% of normal renal function dose AD CAPD: 3-4 mg lost per L dialysate per day > 50-90 10-50 HD: Dose AD (refer to timing of dose) CAPD: Dose for CrCl < 10 < 10 250 .12 hr Dose for CRRT: 0.0 gm q 8 hr > 50-90 10-50 < 10 >80 60-80 40-60 30-40 20-30 10-20 <10.8 hr 250 mg q 6 .5-1 gm bid 125 .5 g q 6 hr 1.5 gm q 24 hr HD: Dose AD CAPD: Dose for CrCl < 10 3 .Dosing information in renal impairment 5 Netilmicin 2 mg/kg q 8 hr Once Daily Dosing Carbapenem antibiotics 6 Imipenem 7 Meropenem 0.5 mg/kg q 24 hr 5 mg/kg q 24 hr 4 mg/kg q 24 hr 2 mg/kg q 24 hr 3 mg/kg q 48 hr 2.

2 g q 8 hr 11 Cefotaxime 2 g q 8 hr 12 Cefoxitin 2 g q 8 hr 13 Ceftazidime 2 g q 8 hr > 50-90 500 mg IV q 8 hr 30-50 250 mg IV q 8 hr >10 .0-2.5 g q 12 hr HD: CAPD: Extra 1 g AD 0.0 g q 24-48 hr 2 g q 8-12 hr 2 g q 12-24 hr 2 g q 24 hr 2 g q 8 hr 2 g q 8-12 hr 2 g q 24-48 hr 2 g q 8-12 hr 2 g q 12-24 hr 2 g q 24-48 hr NO data HD: Dose as for CrCl <10.5-1 g AD 0.0 gm q 24 hr Cephalosporin Antibiotics 10 Cefazolin Sodium 1 .0 g q 12 hr 1.5 g q 24 hr 4 .0-2.5-1 g q 24 hr HD: CAPD: Extra 1 g AD 1 g q 24 hr HD: CAPD: Extra 1 g AD 0. give 150 mg supplement AD HD: CAPD: 0.< 30 250 mg IV q 12 hr <10 no data > 50-90 1 gm q 24 hr 10-50 0.Dosing information in renal impairment 8 Doripenem 500 mg IV q 8 hr 9 Ertapenem 1.0 g q 8 hr 1.5 gm q 24 hr (CrCl < 30 ) < 10 0.if dosed < 6 hrs prior to HD.5 gm q 24 hr > 50-90 10-50 < 10 > 50-90 10-50 < 10 > 50-90 10-50 < 10 > 50-90 10-50 < 10 1.0-2.

0.75 g q 12 hr < 10 0.75-1.5 g) 1.Dosing information in renal impairment 14 Cefuroxime Sodium inj.5 g (Sulperazon® 1.5 g q 8 hr 10-20 0.5 g Sulperazon AD No adjustment HD: Dose AD CAPD: 1 g q 12 hr HD: Dose AD CAPD: Dose as for CrCl < 10 HD: Normal Dose AD CAPD: Dose as for CrCl < 50 HD : Extra 1 gm AD CAPD : 1-2 gm q 48 hr 5 .12 g of 2:1 ratio Max. Sulbactam 2 g/day (1 g q 12 h) <15 Max.75 g q 24 hr 15-30 Max.5 E 3 g/ day IM or IV Divided q 12 hr up to Max.8 hr 2.0 gm q 8 hr (max dose) > 20 0.75-1. Sulbactam 1 g/day (500 mg q 12h) No adjustment in renal failure 10-20 < 10 < 50 > 50-90 10-50 < 10 normal dose q 12 hr normal dose q 24 hr 250-500 mg q 12 hr 2 gm q 8 hr 2 gm q 12-24 hr same dose for CRRT 1 gm q 24 hr HD: CAPD: Dose AD Dose for CrCl < 10 HD: CAPD: 1. Sulbactam 4 g/day 16 Ceftriaxone 1-2 g q 12-24 hr 17 250-500 mg q 12 hr 18 Cefuroxime axetil (oral form) Cephalexin 19 Cefepime 250-500 mg orally q 6 .5 g q 8 hr 15 Cefoperazone 1 g +Sulbactam 0.

400 mg q 12 hr 23 Ciprofloxacin. then 200 mg q 24 hr same dose fro CRRT < 10 400 mg.Dosing information in renal impairment Fluoroquinolone Antibiotics 20 Ciprofloxacin inj. then 200 mg q 24 hr > 50-90 320 mg q 24 hr HD: CAPD: 200 mg IV q 12 hr 200 mg IV q 8 hr HD: Dose as for CrCl < 10 CAPD: Insufficient data HD : 50% of usual dose q 24 hr CAPD: 300 mg q 24 hr HD: 250 q 12 hrDose AD CAPD: 250 q 8 hr HD: 200 mg q 24 hr AD CAPD: 200 mg q 24 hr HD: 160 mg q 24 hr AD 6 . oral 500-750 mg q 12 hr 20-50 < 20 > 50-90 10-50 < 10 24 Gatifloxacin 400 mg po/IV q 24 hr 25 Gemifloxacin 320 mg po q 24 hr > 50-90 10-50 100% 400 mg IV q 24 hr 50% 400 mg q 24 hr usual dose q 24 hr 50% of usual dose q 24 hr no change 50-75% of dose 50% of dose 400 mg q 24 hr 400 mg. 400 mg q 12 hr or > 50-90 10-50 < 10 21 Norfloxacin 400 mg q 12 hr < 30 22 Ofloxacin 200 .

PO > 50-90 750 mg q 24 hr 20-49 750 mg q 48 hr <20 750 mg once. then 500 mg q 48 hr HD/CAPD Dose for CrCl < 20 0.4 doses/day 150 mg colistin base/vial 30 160 mg q 24 hr 160 mg q 24 hr Non-PJP: 1 DS Tablet every 12 hr PJP prophylaxis: one DS tablet daily 100% of normal dose 75% of normal dose 50-75% of normal dose 100% 100% 50-75% > 80-100 100-150 mg q8-12 hr (300 mg/day) 40-70 75-115 mg q 12 hr 25-40 66-150 mg q 12 -24 hr 10-25 100-150 mg q 36 hr >30 Usual dose < 15 Administer 50% of recommend dose < 15 Not recommended HD: Dose AD CAPD: none HD: 80 mg AD HD: Avoid if possible. give 50% of Maintenance dose q 24 hr on dialysis day dose AD 7 .5 E 5 mg /kg/day (Colistimethate Sodium) Divided 2 . If unavoidable.5-1 g q 12 hr > 50-90 10-50 < 10 > 50-90 10-50 < 10 HD: Normal Dose AD CAPD: none 250-500 mg q 6 hr Miscellaneous Antibacterial Antibiotics 29 Colistin 2.Dosing information in renal impairment 10-50 < 10 26 Levofloxacin Macrolide Antibiotics 27 Clarithromycin 28 Erythromycin Cotrimoxazole (Tablet: TMP 80 mg/ SMZ 400 mg ) CAPD: 160 mg q 24 hr 750 mg q 24 hr IV.

7 g/day in No adjustment in renal failure 2.2-2.Dosing information in renal impairment 31 Trimethoprimsulfamethoxazole-DS 32 Vancomycin 33 Clindamycin phosphate inj.2 g กKLMNOPQORS HD 1 g q 24 .4 divided dose 2-4 g/ day in 80-100 2 g q 12 hr 2 divided doses 40-50 1 g q 12 hr 20-30 500 mg q 12 hr CAPD: Insufficient data Not recommended: but if used: 5-10 mg/kg q 24 hr HD/CAPD: Dose for CrCl < 10 No adjustment HD: CAPD 1 .5 mg/kg q 8 hr same dose for CRRT 10-29 5-10 mg/kg q 12 hr < 10 not recommend but if used 5-10 mg/kg per dose q 24 hr Prophylaxis : 1 tab po q >50-90 100% 24 hr or 3 times per week 10-50 100% <10 100% 1 g q 12 hr > 50-90 1 g q 12 hr 10-50 1 g q 24-96 hr < 10 1 g q 4-7 days 1. 34 Fosfomycin PJP treatment:: 15-20 mg (TMP)/kg/day divided q 6-8 hr Treatment : 5-20 mg/kg/day divided q 6-12 hr > 50-90 5-20 mg/kg/d divided q 6-12 hr 30-50 5-7.36 hr 8 .

2-2.25 .3.3.5 g q 6 hr > 50-90 10-50 < 10 36 Clindamycin (oral form) Penicillin Antibiotics 33 Amoxillin(AM) / clavulanate (oral form) 150-450 mg q 6 hr 500 mg/ 125 mg q 8 hr > 50-90 10-50 < 10 34 Ampicillin 250 mg E 2 gm q 6 hr 35 Ampicillin/sulbactam 2 gm AM + 1 gm SB or 1 gm AM + 0.0 q 24 hr 75% 20-50% HD: Dose AD CAPD: 2 gm AM/1 gm SB q 24 hr HD : A maintenance dose may be given to patients following HD 9 .4 million units Single 10-50 dose < 10 q 6 hr q 6-12 hr q 12-24 hr No adjustment in renal failure No adjustment No adjustment 500/125 mg AM component q 8 hr 250-500 mg of AM component q 12 hr 250-500 mg of AM component q 24 hr HD: As for CrCl < 10 extra dose after dialysis 0.25 .0 g q 12 hr 1.2 g q 6-12 hr 0.3.Dosing information in renal impairment 35 Lincomycin 0.0 g q 6-8 hr 1 .5 .2 g q 6 hr 0.5 . 5 .2 g q 12-24 hr HD: Dose AD CAPD: 250 mg q 12 hr 1.5g SB Iv q 6-8 hr 36 Benzathine Penicillin > 50-90 10-50 < 10 ( ≥30 ) (15-29) (5-14) 1.25 .

2 G IV stat followed 600 mg IV q 12 hr < 10 1.5 gm q 6-8 hr No adjustment in renal failure > 50-90 100% of dose 10-50 75% of dose < 10 20-25% of dose > 50-90 no change 10-50 q 8-12 hr < 10 q 24 hr > 30 no change 10 . 1.5 gm q 12 hr.25 gm q 8 hr CAPD : 20 E 50% normal dose q 6 hr No adjustment HD: Dose AD CAPD: Dose for CrCl < 10 HD: dose AD CAPD: 250 mg q 12 hr HD: add 600 mg IV dose AD No adjustment HD: Dose for CrCl<10 +0.2g ) 1.5 gm q 48 hr 10 .75 gm AD CAPD: 4. CRRT: 4.Dosing information in renal impairment 37 38 Cloxacillin inj Penicillin G 250-500 mg q 6 hr 0.30 1.375-4.2 G IV stat followed 600 mg IV q 24 hr No adjustment in renal failure > 50-90 100% 10-50 2.2 G IV q 8 hr 40 Dicloxacillin 125-500 mg q 6 hr 41 Piperacillin(P)/Tazobactam(T) 3.25 gm q 6 hr if CrCl< 20 q 8 hr same dose for CRRT < 10 2.5-4 million Unit q 4 hr 38 Amoxycillin 250-500 mg q 8 hr 39 Amoxycillin/Clavulanic acid (Augmentin® inj.

Dosing information in renal impairment Tetracycline Antibiotics 42 Tetracycline 43 Doxycycline Antifungal antibiotics 44 Amphotericin B 45 Fluconazole 46 1) Itraconazole. po soln 2) Itraconazole.500 mg q 6-12 hr 100 mg q 12 hr >50-90 10-50 < 10 q 8-12 hr q 12-24 hr q 24 hr No adjustment in renal failure UVWXYPZRSกXYUก[\][^_KL`_ (Nephrotoxicity) aMbcdefZghXZP`_iก]YKLS Non. IV 47 Terbinafine 250 .4-1 mg/ kg q 24 hr > 50-90 q 24 hr ABLC: 5 mg/kg/day 10-50 q 24 hr LAB: 3-5 mg/kg/day < 10 q 24 hr 100 .400 mg q 24 hr > 50-90 100% 10-50 50% < 10 50% 100-200 mg q 12 hr > 50-90 100% 10-50 100% < 10 50% 200 mg IV q 12 hr > 50-90 200 mg IV bid < 50 Do not use IV form if CrCl < 30 due to accumulation of carrier: cyclodextrin 250 mg po per day > 50-90 q 24 hr < 50 jZYQOkกUOklgSกXYamdaMbcdefZg HD/CAPD: None No adjustment HD: CAPD: No adjustment No adjustment HD: 100% of recommended dose AD CAPD: Dose for CrCl < 10 HD/CAPD :oral solution 100 mg q 1224 hr 11 .lipid: 0.

then 4 mg/kg q 12 hr 49 Griseofluvin Microsize: 0. Switch to po or DC Insufficient data Insufficient data No dose adjustment No dose adjustment 12 . Of IV vehicle (cyclodextrin).dose of 750 mg/day) 200-400 mg/day as a single daily dose 50 Ketoconazole > 50-90 No adjustment If CrCl < 50 ml/min. accum.Dosing information in renal impairment 48 Voriconazole 6 mg/kg IV q 12 hr times 2.5-1 g q 24 hr in single or divided doses Ultramicrosize: 375 mg q 24 hr in single or divided doses (max.

000 units q 8 hr 15-25 mg/kg q 24 hr 5 mg/kg q 24 hr (max 300 mg) Insufficient data Insufficient data ≥ 50-90 q 24 hr 10-50 q 24-36 hr < 10 q 48 hr No adjustment HD: CAPD: Dose AD Dose for CrCl < 10 HD: CAPD: Dose AD Dose for CrCl < 10 13 . Oral: 500.Dosing information in renal impairment 51 Nystatin Antituberculous Antibiotics 52 Ethambutol 53 Isoniazid (INH) Oral candidiasis. 400.000.000 units to each side of mouth qid Intestinal infections.000-600.000-1.

5 g q 24 hr) ≥ 50-90 10-50 < 10 No adjustment No adjustment 12 .4 mg/kg q 8 hr > 50-90 10-50 < 10 > 50-90 10-50 < 10 100% q 8 hr 100% q 12-24 hr 50% q 24 hr 10 mg q 24 hr 10 mg q 48-72 hr 10 mg q 72 hr HD: CAPD: Dose AD Dose for CrCl < 10 Antiviral Agents for Antiretroviral 56 Acyclovir.25 mg/kg q 24 hr HD: 40 mg/kg 24 hrs before each 3x / week dialysis CAPD: No reduction 55 Rifampicin (Rifampin) 600 mg q 24 hr ≥ 50-90 10-50 < 10 No adjustment 300-600 mg q 24 hr 300-600 mg q 24 hr HD: CAPD: No adjustment Dose for CrCl < 10 5-12.Dosing information in renal impairment 54 Pyrazinamide 25 mg/kg q 24 hr (max 2. IV 57 Adefovir 10 mg po q 24 hr 58 Atazanavir ARV-naïve pts: Atazanavir 300 mg OD plus ritonavir 100 mg OD or 400 mg OD in patients unable to tolerate ritonavir No adjustment HD: 10 mg q week AD CAPD: No data Use boosted therapy of atazanavir 300 mg with ritonavir 100 mg OD 14 .

experienced pts: Atazanavir 300 mg OD plus ritonavir 100 mg OD 59 1) Ganciclovir.5 mg 3 times/wk 75 mg q 12 hr 75 mg bid 75 mg once daily Insufficient data 1 g q 8 hr 1 g q 12-24 hr 0. IV Induction 5 mg/kg q 12 hr IV Maintenance 5 mg/kg q 24 hr IV 2) Ganciclovir.5-1 g tid 0. po 1 g tid 60 Oseltamivir 75 mg bid 61 Valacyclovir 1 g q 8 hr 62 Lamivudine 300 mg po q 24 hr > 50-90 10-50 < 10 > 50-90 10-50 < 10 > 50-90 10-50 < 10 > 50-90 31-50 10.625 mg/kg 3 times/wk 0.30 < 10 > 50-90 10-50 < 10 > 50-90 10-50 5 mg/kg q 12 hr 1.25 mg/kg 3 times/wk 2.5-1 g q 24 hr 0.5 mg/kg q 24 hr 1.6 mg/kg AD Dose for CrCl < 10 HD: 0.5-5 mg/kg q 24 hr 0.5 g q 24 hr 300 mg q 24 hr 50-150 mg q 24 hr HD: CAPD: Dose AD Dose for CrCl < 10 HD: CAPD: 0.6-1.25-2.5 g AD HD: CAPD: 30 mg noก 2 YLi HD 30 mg once per week HD: CAPD: Dose AD Dose for CrCl < 10 HD: CAPD: Dose AD Dose for CrCl < 10 15 .Dosing information in renal impairment Not recommended ARV.25 mg/kg q 24 hr 0.

dose) 30-40 mg q 12 hr 67 Zidovudine 300 mg q 12 hr ≥ 20 25-50 mg q 24 hr Insufficient data No adjustment An additional 200 mg dose is recommended following HD No adjustment Insufficient data > 50-90 10-50 < 10 > 50-90 10-50 < 10 100% 50% q 12-24 hr ≥ 60 kg 20 mg/day < 60 kg 15 mg/day No adjustment No adjustment 100 mg q 8 hr HD: CAPD CRRT Dose as for CrCl < 10 AD No data Full dose HD: Dose for CrCl < 10 AD CAPD : Dose for CrCl < 10 16 . 400 mg bid Days 3. 300 mg bid Days 2.Dosing information in renal impairment < 10 63 64 Nelfinavir Nevirapine 750 mg tid orally or 1250 bid Initial : 200 mg OD x 14 days Maintenance: 200 mg bid 65 Ritonavir 66 Stavudine 600 mg bid Escalate the dose as follows: Days 1. 500 mg bid Then 600 mg bid (max.

2011) 012345678 : 98:. Myrna Y.Comp Inc .govt.Thomsonhc com.com. Gilbert DN . |[Ygo O[irXZ 17 .nz (accessed on 17 March. Available at : http// www. Micromedex Health Care Seires. (Electronic version) Thomson Micromedex. Am Fam Physician 2007. jcKpqLกXYeYRirMX\gXaMbcdefZgsYj`_ SXMZ[mXกXYNOPUhtRmtMUnu กOoKpSXMUhtRmกYYp sYS]gXiXOQX\aQvK U\qLMUp^XgM 2552 2.(accessed on 29 October.<=4>=:. Drug information Handbook 2009.) 6.2010 18th ed Philadelphia Lexi.2010.) 5. t[Y[mRg mcu[Y[ Muh.40 th ed . Lacy CF. bกXpXu QOKLto]YYx]Y Muh. et al . USA. et al. uu[{Y mMP Muh. 2010 4.6? @6A 1555 ( 29 F4:G8HI 2553) hv. 2009 3.Dosing information in renal impairment Reference 1. nRuMX U_[pjORS hก. http://www.75 :1487-96. (accessed on 7 October .medsafe. Available at: http// www. Antimicrobial Therapy. The Sanford guide to antimicrobial therapy . Inc. 7. Cololrado.2010.globalrph. xYSjyuRก\[z MoKMsm_[ Muh. Drug dosing adjustments in patients with chronic kidney disease. Munar and Harleen Singh. Greenwood Village.

Dosing information in renal impairment 18 .