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Dosing: Adult Antimicrobial Dosing, Non-dialysis
Short Infusion Dosing (PREFERRED)
| Indication | CrCl > 60 mL/min | 30 - 60 mL/min | 10 - 29 mL/min | < 10 mL/min |
|---|---|---|---|---|
| Non-severe infections including cystitis | 2 g IV q12h | 2 g IV q24h | 1 g IV q24h | 500 mg IV q24h |
| Severe infections including febrile neutropenia, meningitis, Pseudomonas aeruginosa | 2 g IV q8h | 2 g IV q12h | 2 g IV q24h | 1 g IV q24h |
Extended Infusion Dosing (if recommended by ID, ID pharmacy, or clinical pharmacy for select populations)
| Indication | CrCl > 60 mL/min | 30 - 60 mL/min | < 30 mL/min |
|---|---|---|---|
| Loading Dose* | 2 g x1 (over 30 minutes) | 2 g x1 (over 30 minutes) | Use short infusion |
| Maintenance: All Indications** | 2 g IV q8h (over 4 hours) | 2 g IV q12h (over 4 hours) | Use short infusion |
*Recommended to start maintenance dose 4 hours after loading dose
**Extended infusion data in meningitis are limited and may require further discussion with ID/ASP providers
Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis
|
Indication |
Intermittent Hemodialysis |
Continuous Hemodialysis |
|---|---|---|
| All Indications |
2 g IV x1 now and post-HD Alternative dosing for patients not on stable hemodialysis schedule: 1 g x1 now, then qPM |
1 g IV q8h* |
*May infuse over 4 hours (extended infusion dosing) if recommended by ID, ID pharmacy, or clinical pharmacy for select populations. A loading dose (over 30 minutes) may be considered when initiating therapy in select patients. If a loading dose is given, start maintenance dose 4 hours after loading dose.
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.