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Dosing Weights
Dosing: Adult Antimicrobial Dosing, Non-dialysis
Use traditional dosing or consult ID pharmacy for guidance
| Indication | CrCl > 60 mL/min | 40-60 mL/min | 20-40 mL/min | <20 mL/min |
|---|---|---|---|---|
| High-dose extended interval ("once-daily"): patients with normal renal function who are not morbidly obese or fluid overloaded. | 7 mg/kg IV q24h | Use traditional dosing or contact pharmacy for assistance | ||
| Traditional dosing: patients who do not qualify for high-dose extended interval dosing | 1.6 mg/kg IV q8h | 1.5 mg/kg IV q12h | 1.5 mg/kg IV q12-24h | 2 mg/kg loading dose IV x1, contact pharmacy for maintenance |
Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis
|
Indication |
Intermittent Hemodialysis |
Continuous Hemodialysis |
|---|---|---|
| All Indications | 2 mg/kg IV x1, then 1 mg/kg IV post-HD | 2 mg/kg IV x1 then 1.5 mg/kg IV q24h |
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.
*If Total BW > 1.2 times Ideal BW, use Adj BW.
Monitoring:
|
Indication |
Monitoring |
|---|---|
| Gram-negative high-dose extended interval ("once-daily") |
Single level: Check random drug level 6-14 hours after the start of infusion. Compare to nomogram. Paired levels: Check peak drug level 1 hour after end of infusion and random level 6-14 hours after infusion. Consult ID pharmacy for assistance. |
| Gram-negative traditional dosing | Paired levels: Check peak drug level 30 minutes after end of infusion (goal 5 - 8 mg/L) and trough level immediately before next dose (goal <2 mg/L). |