Dosing: Adult Antimicrobial Dosing, Non-dialysis
| Indication | Dose | Notes |
|---|---|---|
| All indications | 70 mg IV x 1, then 50 mg IV q24h | No renal dose adjustment. Increase maintenance dose to 70 mg when given with CYP3A4 inducers (phenytoin, rifampin, carbamazepine, dexamethasone, or efavirenz). |
| Endovascular or cardiac device-associated infection | 150 mg IV q24h |
Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis
| Indication | Dose | Notes |
|---|---|---|
| All indications | 70 mg IV x 1, then 50 mg IV q24h | No dose adjustment in hemodialysis. Increase maintenance dose to 70 mg when given with CYP3A4 inducers (phenytoin, rifampin, carbamazepine, dexamethasone, or efavirenz). |
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.
Unrestricted Indications (select indication on order entry):
1) Documented sterile site (not urine or respiratory) infection with microbiologically confirmed Candida glabrata or Candida kruseii
2) Documented sterile site infection (not urine or respiratory) infection with yeast, pending species identification
3) Prophylaxis against fungal infections in patients on the hematology/oncology/BMT service with intolerance of or contraindications to azoles
4) Empiric therapy for prolonged febrile neutropenia in hematology/oncology/BMT patient
All other indications require approval from the Antimicrobial Stewardship Program or consulting ID fellow