Revision of TMP/SMX from Apr 22, 2020

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

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis


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

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