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Dosing Weights
Dosing: Adult Antimicrobial Dosing, Non-dialysis
| Indication |
Dose |
Notes |
|---|---|---|
| Invasive fungal infections | 5 mg/kg IV q24h |
No adjustment for renal dysfunction; monitor serum creatinine and electrolytes |
| Mold prophylaxis (Heme/BMT) | 3 mg/kg IV q24h |
Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis
|
Indication |
Intermittent Hemodialysis |
Continuous Hemodialysis |
|---|---|---|
| Invasive fungal infections | 5 mg/kg IV q24h | 5 mg/kg IV q24h |
| Prophylaxis (heme/BMT) | 3 mg/kg IV q24h | 3 mg/kg IV q24h |
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.
*Use Total Body Weight if Total Body Weight < Ideal Body Weight. If Total Body Weight >1.2 times Ideal Body Weight, use Adjusted Body Weight
IV Fluids: Give 500mL Normal Saline before and after AmBisome administration if able to tolerate
Restricted to ID or Antimicrobial Stewardship except:
1) Documented or suspected fungal pneumonia in a patient intolerant of or with contraindications to azoles
2) Prophylaxis against fungal infections in patients on the hematology/BMT service or lung transplant service
3) Empiric therapy for prolonged febrile neutropenia in hematology/oncology/BMT patient