Primary tabs
Dosing: Adult Antimicrobial Dosing, Non-dialysis
| Indication | Dosing | Notes |
|---|---|---|
| All Indications (IV or Delayed-release tablet) | 300 mg IV/PO q12h x 2 doses, then 300 mg IV/PO q24h | No renal dose adjustment (avoid IV if possible in patients with CrCl <50 mL/min due to accumulation of IV vehicle) |
Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis
| Indication | Dosing | Notes |
|---|---|---|
| All Indications (IV or Delayed-release tablet) | 300 mg IV/PO q12h x 2 doses, then 300 mg IV/PO q24h | No dose adjustment in hemodialysis |
Dialysis Notes
Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR.
General Considerations
- For assistance with therapeutic drug monitoring (TDM), see Azole TDM Reference Document.
- Posaconazole SOLUTION has more frequent dosing, low bioavailability, and significant food restrictions. Do not substitute SOLUTION for TABLETS or IV without discussion with ID Pharmacy.
- Review medications for potential drug interactions.
IV formulation - Restriced to ID or Antimicrobial Stewardship except:
Inability to tolerate or absorb enteral medications and one of the following:
1) Prophylaxis against fungal infections in patients on the hematology/BMT/lung/heart transplant services with an intolerance of or contraindications to voriconazole
2) Suspected or documented serious fungal infection in the hematology/BMT or lung transplant services
3) Empiric therapy for prolonged febrile neutropenia in hematology/oncology/BMT patient
PO formulation - Restricted to ID or Antimicrobial Stewardship except:
1) Prophylaxis against fungal infections in patients on the hematology/BMT/lung/heart transplant services with an intolerance of or contraindications to voriconazole
2) Suspected or documented serious fungal infection in the hematology/BMT or lung transplant services
3) Empiric therapy for prolonged febrile neutropenia in hematology/oncology/BMT patient