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Dosing Weights
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 |
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| 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
|
Indication |
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.
Monitoring
|
Indication |
Monitoring |
|---|---|
| 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). |
Nomogram:
**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