Page 14 - Parkview Antimicrobial Stewardship Guidebook_Neat

Medication Dosing Adjustment Comments
Cefoxitin Normal dose: 1-2 g IV q6-8h
(Mefoxin)
Renal Impairment:
CrCl 30-50 mL/min 1-2 g q8-12h
CrCl 11-34 mL/min 1-2 g q12-24
CrCl 5-9 mL/min 0.5-1 g q12-24h
CrCl < 5 mL/min 0.5-1 g q24-48h
Hemodialysis Loading dose of 1-2 g after dialysis; maintenance dose
as above
Cefuroxime Normal dose: 0.75-1.5 g IV q8h *Preferred
(Ceftin) minimum dose
Renal Impairment: 1.5g q24h
CrCl 10-20 mL/min Usual dose q12h
CrCl < 10 mL/min Usual dose q24h
Hemodialysis Additional dose based on indication should be given
after HD; maintenance dose as above
Cephalexin Normal dose: 250-1000 mg PO q6h
(Keflex)
Renal Impairment:
CrCl 30-59 mL/min Max daily dose of 1000 mg
CrCl 15-29 mL/min 250 mg q8-12h
CrCl 5-14 mL/min 250 mg q24h
CrCl < 14 mL/min 250 mg q48-60
Hemodialysis 250-500 mg q12-24h; administer after HD on HD days

Ciprofloxacin Normal dose: IV: 400 mg q8-12h *preferred dose
(Cipro) PO: 500-750 mg q12h is underlined

Renal Impairment:
CrCl > 50 mL/min Normal dose
CrCl 30-50 mL/min Normal IV dose
250-500 mg PO q12h
CrCl 5-29 mL/min 200-400 mg IV q18h-q24h
250-500 mg PO q18h
Hemodialysis 200-400 mg IV q24h (after dialysis on dialysis days)
250-500 mg PO q24h (after dialysis on dialysis days)
Daptomycin Normal dose: 4-6 mg/kg IV q24h (can be dosed up to 10 mg/kg) 4 mg/kg used for
(Cubicin) skin/skin
Renal Impairment: structure
CrCl > 30 mL/min Normal dose infections only
CrCl < 30 mL/min Extend interval to q48h
Hemodialysis Administer 6 mg/kg after dialysis sessions (3 times a *dose based on
week) IBW
Ertapenem Normal dose: 1 g IV q24h Should not be
(Invanz) given in D5W
Renal Impairment:
CrCl > 30 mL/min Normal dose Therapy may be
CrCl < 30 mL/min 500 mg IV q24h administered for
Hemodialysis 500 mg IV q24h (give at least 6 hours after dialysis) up to 14 days