Dosing: Adult Antimicrobial Dosing, Non-dialysis
| Indication | CrCl > 50 mL/min | 20-49 mL/min | <20mL/min |
|---|---|---|---|
| Urinary tract infections | 500mg IV/PO Q24h | 500 mgx1, then 250mg IV/PO Q24h | 500mg x1, then 250mg IV/PO Q48h |
| Other indications, including Gram-Negative Bloodstream Infection | 750mg IV/PO Q24h | 750mg IV/PO Q48h | 750mg x1, then 500mg IV/PO Q48h |
| Prophylaxis in neutropenic patients on the Heme/BMT service | 500 mg PO Q24h​ | 250 mg PO Q24h | 250 mg PO Q48h |
Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis
| Indication | Intermittent Hemodialysis | Continuous Hemodialysis |
|---|---|---|
| Standard Dosing | 500mg x1, then 250 mg IV/PO Q48h | 750 mg IV/PO x1, then 250 mg IV/PO q24h |
| Pneumonia, Gram-Negative Bloodstream Infection, or Pseudomonas infections | 750mg x1, then 500mg IV/PO Q48h | 750 mg IV/PO x1, then 500 mg IV q24h |
| Prophylaxis in neutropenic patients on the Heme/BMT service | 500mg x1, then 250 mg PO Q48h | 500mg x1, then 250 mg PO Q24h |
Dialysis Notes
Dialysis Notes
Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR.
Avoid co-administration of the oral formulation with divalent/trivalent cations (e.g. calcium, magnesium, zinc) - separate by at least 2 hours.