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Dosing: Adult Antimicrobial Dosing, Non-dialysis
Extended Infusion Dosing (PREFERRED for UCSF)
| Indication | CrCl > 20 mL/min | <20 mL/min |
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UCSF: All Infections, including documented/suspected Pseudomonas UCSF exclusion criteria for EXTENDED INFUSION: resistant or intermediate susceptibility organism, cystic fibrosis, peri-procedural areas, insufficient IV access ZSFG: Use EXTENDED INFUSION when recommended by ID pharmacist or ID fellow |
Loading dose = 4.5 g IV over 30 min x1, then 4.5 g IV infused over 4h every 8h (starting immediately after loading dose) |
Use SHORT INFUSION piperacillin/tazobactam |
See Adult Extended Infusion Piperacillin-Tazobactam protocol for additional details
Short Infusion Dosing
| Indication | > 50 mL/min | 10 – 50 mL/min | < 10 mL/min |
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UCSF: Use SHORT INFUSION only for patients excluded from EXTENDED INFUSION dosing ZSFG: Use SHORT INFUSION unless EXTENDED infusion is recommended by ID |
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Non-Pseudomonas infections |
3.375 g IV q6h |
3.375 g IV q8h |
2.25 g IV q8h |
| Documented/Suspected Pseudomonas aeruginosa infection |
CrCl > 20 mL/min: 4.5 g IV q6h |
CrCl < 20 mL/min: 3.375 g IV q8h |
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Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis
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Indication |
Intermittent Hemodialysis |
Continuous Hemodialysis |
|---|---|---|
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UCSF: All Infections, including documented/suspected Pseudomonas UCSF: Exclusion criteria for EXTENDED INFUSION: resistant or intermediate susceptibility organism, cystic fibrosis, peri-procedural areas, insufficient IV access |
2.25 g IV q8h (SHORT infusion over 30 minutes) |
UCSF: Loading dose = 4.5 g IV over 30 min x1, then 4.5 g IV infused over 4h every 8h (starting immediately after loading dose) ZSFG: 4.5 g IV q8h (SHORT infusion over 30 minutes) |
Dialysis Notes
Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min.
UCSF: Extended infusion is the PREFERRED dosing strategy if no exclusions
ZSFG: Available upon ID pharmacy or ID fellow recommendation