Dosing: Adult Antimicrobial Dosing, Non-dialysis
- All dosing for foscarnet is done by the foscarnet CrCl, which is calculated using the modified Cockcroft-Gault equation above. Note that no weight is used in this calculation.
- Do NOT use the CrCl calculated by Cockcroft-Gault equation.
- Dose-related nephrotoxicity occurs commonly; monitor and evaluate SCr daily, and recalculate foscarnet CrCl for acute changes in SCr to evaluate need for renal-dose adjustments.
|
Indication |
Foscarnet CrCl - use equation above | ||||||
|---|---|---|---|---|---|---|---|
|
> 1.4 mL/min/kg |
> 1.0 - 1.4 mL/min/kg | > 0.8 - 1.0 mL/min/kg | > 0.6 - 0.8 mL/min/kg |
> 0.5 - 0.6 mL/min/kg |
≥ 0.4 - 0.5 mL/min/kg |
< 0.4 mL/min/kg |
|
| CMV Induction duration depends on clinical response |
90 mg/kg IV q12h |
70 mg/kg IV q12h | 50 mg/kg IV q12h | 80 mg/kg IV q24h |
60 mg/kg IV q24h |
50 mg/kg IV q24h |
Not recommended |
|
CMV Maintenance* |
90 mg/kg IV q24h |
70 mg/kg IV q24h | 50 mg/kg IV q24h | 80 mg/kg IV q48h |
60 mg/kg IV q48h |
50 mg/kg IV q48h |
Not recommended |
| Acyclovir-Resistant Mucocutaneous HSV* |
40 mg/kg IV q8h |
30 mg/kg IV q8h |
35 mg/kg IV q12h |
25 mg/kg IV q12h |
40 mg/kg IV q24h |
35 mg/kg IV q24h |
Not recommended |
*There may be alternative dosing strategies available or situations that may benefit from higher/lower dosing. Speak to ASP/ID pharmacy if needed.
At UCSF, there is an adult inpatient order panel available for use – Foscarnet (FOSCAVIR) IV Panel (adult)
IV Fluids: IV hydration lowers risk for nephrotoxicity and penile ulcerations. Give 750 - 1000 mL normal saline or 500 mL normal saline for doses ≤ 60 mg/kg before each dose.
Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis
|
Indication |
Intermittent Hemodialysis |
Continuous Hemodialysis |
|---|---|---|
| CMV (Induction and Maintenance)* |
60 mg/kg IV post-HD |
Minimal data; consult ASP/ID pharmacy for assistance |
| Acyclovir-Resistant Mucocutaneous HSV* | 45 mg/kg IV post-HD | Minimal data; consult ASP/ID pharmacy for assistance |
*There may be alternative dosing strategies available or situations that may benefit from higher/lower dosing. Speak to ASP/ID pharmacy if needed.
At UCSF, there is an adult inpatient order panel available for use – Foscarnet (FOSCAVIR) IV Panel (adult)
Dialysis Notes
Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min.
Restricted to ID or Antimicrobial Stewardship except:
1) For treatment or prophylaxis against viral infection in BMT patient