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| Revision | Operations | |
|---|---|---|
| 02-7-25 by ripal121 ripal121 replaced Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR with Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min. via Scanner Search and Replace module. | current revision | |
| 02-7-25 by ripal121 ripal121 replaced Intermittent HD with Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min. via Scanner Search and Replace module. | ||
| 02-7-25 by conan.macdougal... [email protected] replaced For detailed view of dialysis dosing and evidence, see <a href="https://idmp.ucsfsitebuilder.acsitefactory.com/content/ucsf-adult-antimicrobial-dosing-dialysis-reference-document">Dosing in Hemodialysis</a> document.</p> with via Scanner Search and Replace module. | ||
| 11-26-24 by ripal121 | ||
| 11-25-24 by ripal121 | ||
| 07-31-24 by kaipe | ||
| 09-20-23 by Annie Kim | ||
| 07-20-23 by ripal121 | ||
| 06-13-22 by conan.macdougal... | ||
| 03-14-22 by conan.macdougal... NEW! Dosing information for micafungin, now the formulary echinocandin at UCSF Medical Center/Benioff Children's Hospital. | ||
Dosing: Adult Antimicrobial Dosing, Non-dialysis
| Indication | Dose | Notes |
|---|---|---|
| Esophageal candidiasis | 150 mg IV daily |
Dosage adjustment not required in renal or hepatic dysfunction |
| *Prophylaxis against Candida in patients with HSCT, neutropenia, hematologic malignancy, or solid organ transplant | 50-100 mg IV daily | |
|
Candidemia Invasive candidiasis Empiric treatment, febrile neutropenia Empiric treatment, non-neutropenic ICU patients |
100 mg IV daily |
* If patient does not have a drug interaction with an azole, but needs micafungin as prophylaxis, these are the lab thresholds: AST or ALT > 3x ULN + new symptoms OR AST or ALT >5 x ULN OR T bilirubin ≥ 3 mg/dL
Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis
| Indication | Dose | Notes |
|---|---|---|
| Esophageal candidiasis | 150 mg IV daily |
Dosage adjustment not required in hemodialysis |
| *Prophylaxis against Candida in patients with HSCT, neutropenia, hematologic malignancy, or solid organ transplant | 50-100 mg IV daily | |
|
Candidemia Invasive candidiasis Empiric treatment, febrile neutropenia Empiric treatment, non-neutropenic ICU patients |
100 mg IV daily |
* Micafungin can be used as an alternative to azole prophylaxis in the setting of drug interaction or hepatotoxicity beyond these lab thresholds: AST or ALT > 3x ULN with new symptoms OR AST or ALT >5 x ULN OR T bilirubin ≥ 3 mg/dL
Dialysis Notes
Restricted to ID or Antimicrobial Stewardship except:
1) Documented sterile site (not urine or respiratory) infection with microbiologically confirmed Candida spp (ID/ASP approval required for durations exceeding 48h)
2) Documented sterile site infection (not urine or respiratory) infection with yeast, pending species identification (ID/ASP approval required for durations exceeding 48h)
3) Prophylaxis against fungal infections in patients on the hematology/oncology/BMT service with intolerance of or contraindications to azoles
4) Empiric therapy for prolonged febrile neutropenia in hematology/oncology/BMT patient