Dosing: Adult Antimicrobial Dosing, Non-dialysis


CrCl > 50 mL/min

25 - 50 mL/min

10 - 25 mL/min

< 10 mL/min 

Non-CNS HSV Infections 5 mg/kg IV q8h 5 mg/kg IV q12h 5 mg/kg IV q24h 2.5 mg/kg IV q24h
HSV encephalitis/ Disseminated VZV 10 mg/kg IV q8h 10 mg/kg IV q12h 10 mg/kg IV q24h 5 mg/kg IV q24h

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis


Intermittent Hemodialysis

Continuous Hemodialysis
Non-CNS HSV Infections 2.5 mg/kg IV x1 now, then qPM 5 mg/kg IV q24h
HSV encephalitis/ Disseminated VZV 5 mg/kg IV x1 now, then qPM 10 mg/kg IV q12h

Dialysis Notes

Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min.  For detailed view of dialysis dosing and evidence, see Dosing in Hemodialysis document.

Dosing weights for acyclovir are controversial. The original package insert recommends dosing on ideal body weight in obesity.  Subsequent studies suggest adjusted body should be used to reduce risk of underdosing.  We recommend initial use of adjusted body weight in obesity with careful monitoring of renal function and mental status with potential for dose reduction as needed.



Heintz BH, Matzke GR, Dager WE. Antimicrobial dosing concepts and recommendations for critically ill adult patients receiving continuous renal replacement therapy or intermittent hemodialysis. Pharmacotherapy. 2009 May;29(5):562-77. doi: 10.1592/phco.29.5.562. PMID: 19397464.