Dosing Weights
Dosing: Adult Antimicrobial Dosing, Non-dialysis
| Indication | CrCl > 30 mL/min | 15-30 mL/min | < 15 mL/min |
|---|---|---|---|
| Bone and joint infections | 8 mg TMP/kg/day divided Q8-12h | 4 mg TMP/kg/day divided Q12-24h | 2 mg TMP/kg Q24h |
| Systemic GNR infections, Nocardia, Stenotrophomonas maltophilia* | 10 mg TMP/kg/day divided Q8-12h | 5 mg TMP/kg/day divided Q12-24h | 2.5 mg TMP/kg Q24h |
| Pneumocystis pneumonia, CNS infections | 15 mg TMP/kg/day divided Q8 – 12h | 7.5 mg TMP/kg/day divided Q12-24h | 5 mg TMP/kg Q24h |
| Prophylaxis for Pneumocystis pneumonia (Heme-BMT) | 1 DS tablet thrice weekly | 1 SS tablet thrice weekly | |
| Prophylaxis for Pneumocystis pneumonia (SOT) | 1 DS tablet thrice weekly | ||
*Certain clinical situations may require double coverage. If this is being considered, please contact adult ID or adult ASP.
Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis
|
Indication |
Intermittent Hemodialysis |
Continuous Hemodialysis |
|---|---|---|
| Bone and joint infections | 2 mg TMP/kg x1 now and qPM | 8 mg TMP/kg/day divided Q 8-12h |
| Systemic GNR Infections, Nocardia, Stenotrophomonas maltophilia* | 2.5 mg TMP/kg x1 now and qPM | 10 mg TMP/kg/day divided q 8-12h |
| Pneumocystis pneumonia, CNS infections | 5 TMP/kg IV x1 now and qPM | 15 mg TMP/kg/day IV divided q8h - q12h |
| Prophylaxis for Pneumocystis pneumonia (Heme-BMT) | 1 SS tablet thrice weekly | 1 DS tablet thrice weekly |
| Prophylaxis for Pneumocystis pneumonia (SOT) | 1 DS tablet thrice weekly | |
*Certain clinical situations may require double coverage. If this is being considered, please contact adult ID or adult ASP.
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.
Single-strength (SS) tablet contains 80 mg trimethoprim (TMP)
Double-strength (DS) tablet contains 160 mg trimethoprim (TMP)
*May consider Total BW for serious infections