Renal Impairment - Antibiotic doses

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Aciclovir (IV)

GFR (mL/min) 25-50
5-10mg/kg every 12 hours

GFR (mL/min) 10-25
5-10mg/kg every 24 hours

GFR (mL/min) <10
2.5-5mg/kg every 24 hours


Aciclovir (oral)

GFR (mL/min) 25-50
Dose as in normal renal function

GFR (mL/min) 10-25
Herpes simplex 200mg 8 hourly or 6 hourly
Herpes zoster 800mg 8 hourly or 12 hourly

GFR (mL/min) <10
Herpes simplex 200mg 12 hourly
Herpes zoster 400mg - 800mg 12 hourly


Amoxicillin

GFR (mL/min) 20-50
Dose as in normal renal function

GFR (mL/min) 10-20
Dose as in normal renal function

GFR (mL/min) <10
250mg – 1g 8 hourly
(max 6g per day in endocarditis)


Amphotericin (IV) Ambisome (liposomal)

GFR (mL/min) 20-50
Dose as in normal renal function

GFR (mL/min) 10-20
Dose as in normal renal function

GFR (mL/min) <10
Dose as in normal renal function


Benzylpenicillin

GFR (mL/min)
20-50ml/min: Dose as in normal renal function

GFR (mL/min)
10-20ml/min: 600mg – 2.4g every 6 hours
depending on severity of infection

GFR (mL/min) <10
600mg – 1.2g every 6 hours
depending on severity of infection


Caspofungin

GFR (mL/min) 20-50
Dose as in normal renal function

GFR (mL/min) 10-20
Dose as in normal renal function

GFR (mL/min) <10
Dose as in normal renal function


Cefalexin

GFR (mL/min)
20-50ml/min: Dose as in normal renal function

GFR (mL/min)
10-20ml/min: 250-500mg 8 hourly or 12hourly

GFR (mL/min) <10
250-500mg 8 hourly or 12hourly


Cefixime

GFR (mL/min)
20-50ml/min: Dose as in normal renal function

GFR (mL/min)
10-20ml/min: Dose as in normal renal function

GFR (mL/min) <10
200mg daily


Cefotaxime

GFR (mL/min)
20-50ml/min: Dose as in normal renal function

GFR (mL/min)
5-20ml/min: Dose as in normal renal function

GFR (mL/min)
<5ml/min: reduce dose by 50% and keep the frequency the same


Ceftazidime

GFR (mL/min)
31-50ml/min: 1 - 2g 12 hourly

GFR (mL/min)
16-30ml/min: 1 - 2g every 24hours

GFR (mL/min)
6-15ml/min: 500mg – 1g every 24hours
<5ml/min: 500mg-1g 48 hourly


Ceftriaxone

GFR (mL/min)
20-50ml/min: Dose as in normal renal function

GFR (mL/min)
10-20ml/min: Dose as in normal renal function

GFR (mL/min) <10
Dose as in normal renal function (maximum 2g daily)


Cefuroxime (IV)

GFR (mL/min)
20-50ml/min: Dose as in normal renal function.

GFR (mL/min)
10-20ml/min:750mg-1.5g 12 hourly

GFR (mL/min) <10
750mg-1.5g 24 hourly


Ciprofloxacin

GFR (mL/min)
30-50ml/min: Dose as in normal renal function

GFR (mL/min)
10-30ml/min: 50-100% of normal dose

GFR (mL/min) <10
50% of normal dose. 100% of normal dose may be given for short periods in acceptional circumstances.


Claithromycin (IV)

GFR (mL/min)
30-50ml/min: Dose as in normal renal function

GFR (mL/min)
10-30ml/min: 250-500mg 12 hourly

GFR (mL/min) <10
250 - 500mg 12 hourly


Clarithromycin (oral)

GFR (mL/min)
30-50ml/min: Dose as in normal renal function

GFR (mL/min)
10-30ml/min: 250-500mg 12 hourly

GFR (mL/min) <10
250mg - 500mg 12 hourly


Co-amoxiclav (IV)

GFR (mL/min)
30-50ml/min: Dose as in normal renal function

GFR (mL/min)
10-30ml/min: 1.2g 12 hourly

GFR (mL/min) <10
1.2g stat, then 600mg 8 hourly

1.2g BD Can be used


Co-amoxiclav (oral)

GFR (mL/min)
30-50ml/min: Dose as in normal renal function

GFR (mL/min)
10-30ml/min: Dose as in normal renal function

GFR (mL/min) <10
Dose as in normal renal function


Erythromycin

GFR (mL/min) 20-50
Dose as in normal renal function

GFR (mL/min) 10-20
Dose as in normal renal function

GFR (mL/min) <10
Dose as in normal renal function


Ethambutol

GFR (mL/min)
20-50ml/min: Dose as in normal renal function

GFR (mL/min)
10-20ml/min: 15mg/kg every 24-36 hours

Another option is 7.5-15mg/kg/day

GFR (mL/min) <10
15mg/kg every 48 hours

Another option is 5-7.5mg/kg/day


Flucloxacillin

GFR (mL/min) 20-50
Dose as in normal renal function

GFR (mL/min) 10-20
Dose as in normal renal function

GFR (mL/min) <10
Dose as in normal renal function up to a total daily dose of 4g


Fluconazole

GFR (mL/min) 20-50
50-100% of normal dose.

GFR (mL/min) 10-20
50-100% of normal dose.

GFR (mL/min) <10
50% of normal dose


Gentamicin

GFR (mL/min)
Refer to Gentamicin Monitoring Guidelines Summary
Once Daily Gentamicin
Traditional Multiple Daily Dosing gentamicin


Isoniazid

GFR (mL/min) 20-50
Dose as in normal renal function

GFR (mL/min) 10-20
Dose as in normal renal function

GFR (mL/min) <10
200-300mg daily


Linezolid

GFR (mL/min) 20-50
Dose as in normal renal function

GFR (mL/min) 10-20
Dose as in normal renal function

GFR (mL/min) <10
Dose as in normal renal function - but monitor closely


Meropenem

GFR (mL/min)
26-50ml/min: 500mg-2g 12 hourly

GFR (mL/min)
10-25ml/min: 500mg-1g 12 hourly or 500mg 8 hourly

GFR (mL/min) <10
500mg-1g 24 hourly


Metronidazole

GFR (mL/min) 20-50
Dose as in normal renal function

GFR (mL/min) 10-20
Dose as in normal renal function

GFR (mL/min) <10
Dose as in normal renal function


Nitrofurantoin

GFR (mL/min)
>45ml/min: Dose as in normal renal function

GFR (mL/min)
<45ml/min - Contraindicated

However, a short course (3 to 7 days) may be used with caution in certain patients with an eGFR of 30 to 44 ml/min/1.73m2. Only prescribe to such patients to treat lower urinary tract infection with suspected or proven multidrug resistant pathogens when the benefits of nitrofurantoin are considered to outweigh the risks of side effects.

 


Rifampicin

GFR (mL/min) 20-50
Dose as in normal renal function

GFR (mL/min) 10-20
Dose as in normal renal function

GFR (mL/min) <10
50-100% of normal dose


Sodium fusidate

GFR (mL/min) 20-50
Dose as in normal renal function

GFR (mL/min) 10-20
Dose as in normal renal function

GFR (mL/min) <10
Dose as in normal renal function


Piperacillin-tazobactam

GFR (mL/min)
40-50ml/min: Dose as in normal renal function

GFR (mL/min)
20-40ml/min: 4.5g 8 hourly

GFR (mL/min)
<20ml/min: 4.5g 12 hourly


Teicoplanin

GFR (mL/min)
>80ml/min: Dose as in normal renal function

GFR (mL/min)
30-80ml/min: Give as normal for 4 days. On the 5th day reduce dose by 50% OR give current dose every 48hrs.

GFR (mL/min)
<30ml/min: Give as normal for 4 days. On the 5th day reduce dose by 66% OR give current dose every 72hrs.


Tigecycline

GFR (mL/min)
20-50ml/min: Dose as in normal renal function

GFR (mL/min)
10-20ml/min: Doses as in normal renal function.

GFR (mL/min)
<10ml/min: Doses as in normal renal function.


Trimethoprim

GFR (mL/min) 25-50
Dose as in normal renal function

GFR (mL/min) 15-25
Dose as in normal renal function

GFR (mL/min) <15
50-100% of normal dose


Vancomycin (IV)

GFR (mL/min) >70
1g BD

GFR (mL/min) 30-70
1g OD

GFR (mL/min) <30
As advised by Microbiology

 

https://www.bfwh.nhs.uk/mobile/amformulary/renal.shtml

 

Joomla Erythromycin Isoniazid Metronidazole Rifampicin Trimethoprim Fluconazole ciprofloxacin Aciclovir Amoxicillin Amphotericin Ambisome Benzylpenicillin Caspofungin Cefalexin Cefixime Cefotaxime Ceftazidime Ceftriaxone Cefuroxime Claithromycin Co-amoxiclav Ethambutol Flucloxacillin Gentamicin Linezolid Meropenem Nitrofurantoin Piperacillin-tazobactam Teicoplanin Tigecycline Vancomycin

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