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Dosing: Adult Antimicrobial Dosing, Non-dialysis
Short Infusion Dosing (PREFERRED)
| Indication | > 50mL/min | 26 - 50 mL/min | 10 - 25 mL/min | < 10mL/min |
|---|---|---|---|---|
| Standard Dosing | 1 g IV q8h | 1 g IV q12h | 500 mg IV q12h | 500 mg IV q24h |
| Meningitis, Cystic Fibrosis | 2 g IV q8h | 2 g IV q12h | 1 g IV Q12h | 1 g IV q24h |
Extended Infusion Dosing (if recommended by ID, ID pharmacy, or clinical pharmacy for select populations)
| Indication | > 50mL/min | 26 - 50 mL/min | < 26 mL/min |
|---|---|---|---|
| Loading Dose* | 1 g x1 (over 30 minutes) | 1 g x1 (over 30 minutes) | Use short infusion |
| Maintenance: Standard Dosing | 1 g IV q8h (over 3 hours) | 1 g IV q12h (over 3 hours) | Use short infusion |
| Maintenance: Meningitis**, Cystic Fibrosis | 2 g IV q8h (over 3 hours) | 2 g IV q12h (over 3 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 (CVVHD) |
|---|---|---|
| Standard Dosing | 500 mg IV x1 now, then qPM | 1 g IV q8h* |
| Cystic Fibrosis | 1000 mg IV x1 now, then qPM | 2 g IV q12h*^ |
| Meningitis | 1000 mg IV x1 now, then qPM | 2 g IV q12h^ |
*May infuse over 3 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. Note that extended infusion data in meningitis is limited and may require further discussion with ID/ASP providers.
^If CVVHD flow rate exceeds 2 L/hr, discuss with ID/ASP pharmacy.
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.