Dosing: Adult Antimicrobial Dosing, Non-dialysis

Indication Criteria to initiate: CrCl >55 mL/min, SCr<1.5 mg/dL, urine protein <100mg/dL Increase in SCr of 0.3-0.4 mg/dL Increase in SCr of >0.5 mg/L or 3+ proteinuria
Systemic Infections: Induction 5 mg/kg IV once weekly WITH probenecid 3 mg/kg IV ever week WITH probenecid Discontinue
Systemic Infections: Maintenance 5 mg/kg IV once every 2 weeks WITH probenecid 3 mg/kg IV every 2 weeks WITH probenecid Discontinue
BK viruria in kidney or bone marrow transplant patients 0.25 - 0.5 mg/kg IV once weekly WITHOUT probenecid

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis


Intermittent Hemodialysis

Continuous Hemodialysis
All Indications Minimal data; consult ID pharmacy for assistance

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.

IV Fluids: Give 1L NS over 1-2 hours prior to cidofovir administration.  If able to tolerate, give an additional 1L NS at the start or immediately after cidofovir administration.

Probenecid: 2g PO 3 hours prior to cidofovir, then 1g PO 2 and 8 hours after cidofovir (total 4g)

Unrestricted Indications (select on order entry):

1) Unrestricted use on the hematology/oncology/BMT service

All other use requires authorization from the Antimicrobial Stewardship Program or consulting ID fellow