Dosing: Adult Antimicrobial Dosing, Non-dialysis

Indication CrCl > 60 mL/min 40 - 60 mL/min 20 - 40 mL/min < 20 mL/min
High-dose extended interval ("once-daily"): patients with normal renal function who are not morbidly obese or fluid overloaded 15 mg/kg IV q24h

Use traditional dosing or consult ID pharmacy for guidance

Traditional dosing: patients who do not qualify for high-dose extended interval dosing 5-7.5 mg/kg IV q8h 5-7.5 mg/kg IV q12h 5-7.5 mg/kg IV q24h 5-7.5 mg/kg IV x1 & consult ID pharmacy for maintenance dose

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis


Intermittent Hemodialysis

Continuous Hemodialysis
All Indications 5-7.5 mg/kg IV x1, re-dose based on levels Loading dose of 10 mg/kg IV x1, then 7.5 mg/kg IV q24-48h

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.




High-dose extended interval ("once-daily")

Single level: Check random drug level 6-14 hours after the start of infusion.  Compare to nomogram (below)

Paired levels: Check peak drug level 2 hours after and random level 6-14 hours after infusion.  Consult ID pharmacy for assistance.

Traditional dosing Paired levels: Check peak drug level 30 minutes after end of infusion (goal 20-30 mg/L) and trough level immediately before next dose (goal <4 mg/L).









**If amikacin 20 mg/kg is used. Adjust the measured level with the following equation before plotting the level onto the Amikacin 15mg/kg Extended Interval Nomogram Level for the plot = Measured level x 0.75

Restricted to ID or Antimicrobial Stewardship for IV amikacin