|
|
Body Weight** |
|||
|---|---|---|---|---|
|
CrCl (mL/min) |
< 60 kg |
60-80 kg |
81-100kg |
> 100kg |
|
>90 mL/min (complicated* infection & age < 65) |
750 mg IV q8h |
1000 mg IV q8h |
1250 mg IV q8h |
1500 mg IV q8h |
|
>90 mL/min (complicated* infection & age > 65 or uncomplicated infection & age < 65) |
1000 mg IV q12h |
1250 mg IV q12h |
1500 mg IV q12h |
1750 mg IV q12h |
|
50-90 mL/min |
750 mg IV q12h |
1000 mg IV q12h |
1250 mg IV q12h |
1500 mg IV q12h |
|
Complicated* & age <65 1000 mg IV q8h |
||||
|
15-49 ml/min |
750 mg IV q24h |
1000 mg IV q24h |
1250 mg IV q24h |
1500 mg IV q24h |
|
<15 ml/min not on dialysis |
10-15 mg/kg IV x1 then re-dose according to levels |
|||
|
CRRT |
10 – 15 mg/kg IV q24h |
|||
|
Intermittent Hemodialysis |
15 – 20 mg/kg IV x 1 then 500 mg IV post-HD ONLY |
|||
|
Peritoneal Dialysis |
10-15 mg/kg IV x 1 then re-dose according to levels |
|||
*Complicated infections: CNS infections, endocarditis, pneumonia, bacteremia, osteomyelitis and sepsis
**Use Total Body Weight for patients <120% of Ideal Body Weight. Use Adjusted Body Weight for patients >120% of Ideal Body Weight.
Recommend loading dose (20-25 mg/kg IV x1) for serious infections including CNS infections, endocarditis, pneumonia, bacteremia, osteomyelitis and sepsis