Dosing Weights
Dosing: Adult Antimicrobial Dosing, Non-dialysis
|
Indication |
CrCl > 50 mL/min |
25 - 50 mL/min |
10 - 25 mL/min |
< 10 mL/min |
|---|---|---|---|---|
| Non-CNS HSV Infections | 5 mg/kg IV q8h | 5 mg/kg IV q12h | 5 mg/kg IV q24h | 2.5 mg/kg IV q24h |
| HSV encephalitis/ Disseminated VZV | 10 mg/kg IV q8h | 10 mg/kg IV q12h | 10 mg/kg IV q24h | 5 mg/kg IV q24h |
| Prophylaxis for Heme-BMT patients |
250 mg/m2/dose IV q12h |
125 mg/m2/dose IV q12h | 125 mg/m2/dose IV q24h | 62.5 mg/m2/dose q24h |
Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis
|
Indication |
Intermittent Hemodialysis |
Continuous Hemodialysis |
|---|---|---|
| Non-CNS HSV Infections | 2.5 mg/kg IV x1 now, then qPM | 5 mg/kg IV q24h |
| HSV encephalitis/ Disseminated VZV | 5 mg/kg IV x1 now, then qPM | 10 mg/kg IV q12h |
| Prophylaxis for Heme-BMT patients |
62.5 mg/m2/dose IV q 24h |
125 mg/m2/dose IV q12h |
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.
Dosing weights for acyclovir are controversial. The original package insert recommends dosing on ideal body weight in obesity. Subsequent studies suggest adjusted body should be used to reduce risk of underdosing. We recommend initial use of adjusted body weight in obesity with careful monitoring of renal function and mental status with potential for dose reduction as needed.
References:
Heintz BH, Matzke GR, Dager WE. Antimicrobial dosing concepts and recommendations for critically ill adult patients receiving continuous renal replacement therapy or intermittent hemodialysis. Pharmacotherapy. 2009 May;29(5):562-77. doi: 10.1592/phco.29.5.562. PMID: 19397464.