Page 13 - Parkview Antimicrobial Stewardship Guidebook_Neat

Medication Dosing Adjustment Comments
Cefazolin Normal dose: 1-2g IV Q6-8h * Preferred 2g if
(Ancef) wt > 60 kg (with
Renal Impairment: increased interval
CrCl 35-54 mL/min Full dose ≥ Q8h changes only in
CrCl 11-34 mL/min 50% of usual dose Q12h renal impairment
CrCl ≤ 10 mL/min 50% of usual dose Q18-24h
Hemodialysis 0.5-1g Q24 (administer after HD on HD days)
Cefepime
(Maxipime) Creatinine
Clearance Dosing Regimen
*Preferred
(ml/min)
>60 (normal) 500 mg Q12H 1 gm Q12H 2 gm Q12H 2 gm Q8H
30-60 500 mg Q24H 1 gm Q24H 2 gm Q24H 2 gm Q12H
11-29 500 mg Q24H 500 mg Q24H 1 gm Q24H 2 gm Q24H
<11 250 mg Q24H 250 mg Q24H 500 mg Q24H 1 gm Q24H
Hemodialysis 1 gm Q24H

Ceftaroline Normal dose: 600 mg IV q12h (can be dosed q8h for endocarditis) PNA duration: 5-7
(Teflaro) days
Renal Impairment:
CrCl > 50 mL/min Normal dose Skin and skin
CrCl 31-50 mL/min 400 mg IV q12h structure
CrCl 15-30 mL/min 300 mg IV q12h duration: 5-14
CrCl < 15 mL/min 200 mg IV q12h days
Hemodialysis 200 mg IV q12h
Ceftazidime Normal dose: 1-2 g IV q8h *preferred dose
(Fortaz) is underlined
Renal Impairment:
CrCl > 50 mL/min Normal dose
CrCl 31-50 mL/min 1 g IV q12h
CrCl 16-30 mL/min 1 g IV q24h
CrCl 6-15 mL/min 500 mg q24h
CrCl < 5 mL/min 500 mg q48h
Hemodialysis 500 mg-1 g q24h (after dialysis on dialysis days) or 1-2 g
q48h
Cefotaxime Normal dose: 1-2 g IV q6-8h *Preferred =
(Claforan) consider 50%
Renal Impairment: decrease from 2 g
*autosub to CrCl < 20 mL/min 50% of usual dose q6h in renal
ceftriaxone impairment
Cefotetan Normal dose: 1-2 g IV q12h *Preferred dose
(Cefotan) underlined
Renal Impairment:
CrCl 10-30 mL/min Usual dose q24h
CrCl < 10 mL/min Usual dose q48h
Hemodialysis 25% dose (500 mg) on days between dialysis and 50% (1
g) dose on day of dialysis