Dosing: Adult Antimicrobial Dosing, Non-dialysis

Indication CrCl > 30 mL/min < 30 mL/min
All indications 8 – 10* mg/kg IV q24h 8 – 10* mg/kg IV q48h

*Doses up to 12 mg/kg may be indicated in treatment of some VRE infections - confer with ID/ID pharmacy.

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis


Intermittent Hemodialysis

Continuous Hemodialysis*
All Indications

8-10 mg/kg IV x1 now and post-HD

Alternate for patients not on stable dialysis schedule: 8-10 mg/kg IV q48h

6 mg/kg IV q24h** or 8-10 mg/kg IV q48h

*These recommendations have not been evaluated for patients receiving continuous renal replacement therapy other than CVVHD (ex. CVVH). 

**Consider this dose for patients receiving high ultrafiltration rates (ex. CVVHD > 2L/hr) and/or patients with severe infections (ex. endocarditis) and/or receiving combination therapy (ex. with ceftaroline). ID pharmacy guidance is strongly recommended for complex cases and/or use in combination therapy.

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 Renal Replacement Therapy document.

*If Total BW >1.2 times ideal body weight, use adjusted body weight

Not effective in treatment of pneumonia.

Restricted to ID or Antimicrobial Stewardship