Page 12 - Parkview Antimicrobial Stewardship Guidebook_Neat

Antimicrobial Renal DosingAntimicrobial Renal Dosing
Antimicrobial Renal Dosingntimicrobial Renal Dosing
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Medication Dosing Adjustment Comments
Acyclovir Normal dose: IV: 5-12.5 mg/kg q8h Obese patients
(Zovirax) PO: 200-800 mg 5x a day should be dosed
Renal Impairment: using IBW for IV
CrCl > 50 mL/min Normal dose formulation
CrCl 25-50 mL/min Extend IV interval q12h
Normal PO dose
CrCl 10-25 mL/min Extend IV interval q24h
Extend PO interval q8h
CrCl < 10 mL/min 50% of IV dose q24h
Extend PO interval q12h
Hemodialysis 2.5-5mg/kg/dose q24h (after dialysis on dialysis days)
Ampicillin Normal dose: IV: 1-2 g q4-6h or 50-250 mg/kg/day in divided doses Max IV dose: 12
PO: 250-500 mg q6h g/day

Renal Impairment:
CrCl > 50 mL/min Normal dose
CrCl 10-50 mL/min Extend interval to q6-12h
CrCl < 10 mL/min Extend interval to q12-24h
Hemodialysis IV: 1-2 g q12-24h (after dialysis on dialysis days)
Ampicillin/ Normal dose: 1.5-3g IV q6h
Sulbactam
(Unasyn) Renal Impairment:
CrCl > 30 mL/min Normal dose
CrCl 15-30 mL/min 1.5-3 g IV q12h
CrCl 5-15 mL/min 1.5-3 g IV q24h
Hemodialysis 1.5-3 g IV q24h (after dialysis on dialysis days)
Amoxicillin Normal dose: 250-1000 mg PO Q8h
(Amoxil)
Renal Impairment:
CrCl 10-29 mL/min 250-500 mg Q12h
CrCl < 10 mL/min 250-500 mg Q24h
Hemodialysis 250-500 mg Q24h; additional dose during and after HD
Amoxicillin / Normal dose: 250-875 mg PO Q8-12h (all doses based on amoxicillin
clavulanate content)
(Augmentin)
Renal Impairment:
CrCl 10-29 mL/min 250-500 mg Q12h
CrCl < 10 mL/min 250-500 mg Q24h
Hemodialysis 250-500 mg Q24h; additional dose during and after HD
Aztreonam Normal dose: 500 mg-2 g q8-12h
(Azactam)
Renal Impairment:
CrCl > 30 mL/min Normal dose
CrCl 10-30 mL/min 50% of dose at usual interval
CrCl < 10 mL/min 25% of dose at usual interval
Hemodialysis Load dose of 500 mg-2 g, followed by 25% of initial dose
at usual interval