Dosing of antimicrobial agents in renal insufficiency

Dosing of Antimicrobial Agents in Renal Insufficiency
Yi Guo, PharmD
Penicillins
Usual Dose
Dosage Adjustment
Drug Name
(normal renal
(in renal
(ml/min)
function)
insufficiency)
Ampicillin
Ampicillin/Sulbactam
(Unasyn)
Penicillin G
Piperacillin/
Tazobactam
Cephalosporins
Usual Dose
Dosage Adjustment (in
Drug Name
(normal renal
(ml/min)
renal insufficiency)
function)
Cefazolin
Cefepime
(Maxipime)
Monobactam
Usual Dose
Dosage Adjustment (in
Drug Name
(normal renal
(ml/min) renal insufficiency)
function)
Aztreonam
(Azactam)
Trimethoprim/Sulfamethoxazole (Bactrim)
Dosage Adjustment
Usual Dose (normal renal
CrCl (ml/min)
(in renal
function)
insufficiency)
Serious Systemic Infections:
Imipenem (Primaxin)
Usual Dose (normal renal
Dosage Adjustment (in renal
function)
(ml/min)
insufficiency)
Acyclovir (Zovirax)
Intravenous route:
CrCl (ml/min)
Dose (mg/kg)
Dosing Interval
*In the treatment of herpes simplex encephalitis or herpes zoster, the dose should be increased to 10 mg/kg. Oral route:
Usual Dose (normal
Dosage Adjustment (in renal
renal function)
(ml/min)
insufficiency)
Ganciclovir (Valcyte)
Dosage Adjustment (in renal
Usual Dose (normal
CrCl (ml/min)
insufficiency)
renal function)
Induction
Maintenance
Induction: 5 mg/kg IV
Maintenance: 5 mg/kg
VIII. Fluconazole (Diflucan)
Dosage Adjustment (in renal
Usual Dose (normal renal
insufficiency): % of
function)
(ml/min)
Recommended Dose
Pharmacy carries Amphotericin B deoxycholate (conventional
Amphotericin) and Amphotericin B lipid complex (Abelcet), not
liposomal Amphotericin B (AmBisome).
a. Amphotericin B deoxycholate: 0.25-1mg/kg/day
b. Amphotericin B lipid complex (Abelcet): 3-5 mg/kg/day
Ciprofloxacin (Cipro)
Usual Dose (normal
Dosage Adjustment (in renal
renal function)
(ml/min)
insufficiency)
Intravenous route:
Oral route:
Hemodialysis 250-500 mg PO q24h is recommended Daptomycin (Cubicin)
Usual Dose (normal
Dosage Adjustment (in renal
renal function)
(ml/min)
insufficiency)
Skin and soft tissue
infection:
S. aureus
bacteremia/right sided
endocarditis:
Polymyxin B
After a 2.5 mg/kg loading dose on the first day of therapy, the following doses should
be administered (1 mg=10,000 units):
CrCl (ml/min)
XIII. Antibiotic Dosing for in Critically Ill Adult Patients Receiving
Continuous Renal Replacement Therapy.

Dosage, by type of renal replacement therapy
CVVH/CVVHD
Amphotericin B
deoxycholate
Amphotericin B lipid
Acyclovir
Ampicilin/subactam
Aztreonam
Cefazolin
Cefepime
Ciprofloxacin
Daptomycin
Fluconazole
Imipenem
Piperacillin-
tazobactam
Polymyxin B
Vancomycin
XIV. Antimicrobial agents for which no reduction of dose is usually needed in
patients with renal insufficiency:
a. Ceftriaxone (Rocephin)
b. Chloramphenicol
c. Clindamycin (Cleocin)
d. Dicloxacillin (Dynapen)
e. Doxycycline
f. Linezolid (Zyvox)
g. Micafungin (Mycamine)
h. Moxifoxacin (Avelox)
i. Nafcillin
j. Oxacillin
k. Tigecycline (Tygacil)
l. Voriconazole (Vfend) (IV formulation not to be used in pt with CrCl <50
ml/min, PO is okay and doesn’t require renal adjustment)

Source: http://as17324.http.sasm3.net/uploadedFiles/departments/medicine/Divisions/Infectious_Diseases/Dosing%20of%20Antimicrobial%20Agents%20in%20Renal%20Insufficiency%202012.pdf