5.0 - Antibiotic Doses in Adults With Impaired Renal Function

Antibiotic  Dose for Normal Renal Function Dosage Adjustment For Renal Failure According to Estimated Creatinine Clearance Doses For Dialysis
> 50 mL/min  10 - 50 mL/min  < 10 mL/min  HD CAPD   CRRT
Aminoglycosides

Amikacin IV

15 mg/kg q24H (max 1.5 gm/day)

Normal

7.5 mg/kg q24H

7.5 mg/kg q48 - 72H


7.5 mg/kg q48 - 72H (dose after dialysis)
OR add supplemental dose 3.25 mg/kg after dialysis on dialysis day (50% dose dialyzable)


7.5 mg/kg q48 - 72H
+
15 - 20 mg lost per litre dialysate per day

7.5 mg/kg q24H

    Multiple Daily Dose
    > 50 mL/min                    7.5 mg/kg q12H
    10 - 50 mL/min                 7.5 mg/kg q24H
    < 10 mL/min                    7.5 mg/kg q48H


Gentamicin IV

3 - 5 mg/kg q24H (in septic shock, up to 7 mg/kg q24H)
¤

 
Normal
¤
 
40 - 59 mL/min: 
3 - 5 mg/kg q36H

20 - 39 mL/min: 
3 - 5 mg/kg q48H

<20 mL/min: 
3 - 5 mg/kg single dose and monitor serum levels
¤

 
3 - 5 mg/kg single dose and monitor serum levels
¤

 
2 - 3 mg/kg loading dose, then 1 - 2 mg/kg q48 - 72H (dose after dialysis)
 
OR

Add supplemental dose 0.5 - 1 mg/kg after dialysis on dialysis day (50% dose dialyzable)
¤
 
2 - 3 mg/kg loading dose, then 1 - 2 mg/kg q48 - 72H

+

8 - 10 mg lost per litre dialysate per day
¤
 
2 - 3 mg/kg loading dose, then 1 - 2.5 mg/kg q24 - 48H
¤
 
    Multiple Daily Dose
    > 50 mL/min                    1 - 1.7 mg/kg q8H
    10 - 50 mL/min            1 - 1.7 mg/kg q12 - 48H
    < 10 mL/min                1 - 1.7 mg/kg q48 - 72H

    ¤


Streptomycin IV / IM


15 mg/kg (max 1 gm) q24H
¤
 
Normal
¤
 
15 mg/kg q24 - 72H
¤
 
15 mg/kg q72 - 96H
¤
 
7.5 mg/kg q48 -72H, dose after dialysis only on dialysis days
¤
 
15 mg/kg q72 - 96H

+

20 - 40 mg lost per litre dialysate per day
¤

 
15 mg/kg q24 - 72H
¤
Antibiotic  Dose for Normal Renal Function Dosage Adjustment For Renal Failure According to Estimated Creatinine Clearance Doses For Dialysis
> 50 mL/min  10 - 50 mL/min  < 10 mL/min  HD CAPD   CRRT
Carbapenem

Ertapenem IV


1 gm q24H
 
Normal
 
30 - 50 mL/min:
1 gm q24H

< 30 mL/min:
0.5 gm q24H

 
0.5 gm q24H
 
0.5 gm q24H (if dose < 6 hours prior to HD, add supplemental dose 150 mg after dialysis)

 
0.5 gm q24H
 
0.5 - 1 gm q24H
 
Imipenem / Cilastatin IV

 
500 mg q6H 
or
1000 mg q8H
 
Normal
 
30 - 59 mL/min:
500 mg q8H

< 30 mL/min:
500 mg q12H
£

 
500 mg q12H
£
 
500 mg q12H, dose after dialysis on dialysis days
£

 
500 mg q12H
£
 
500 mg q6 - 8H
or
1000 mg q8H
£
 
For intermediate sensitivity to Imipenem or CRE combination therapy:
1000 mg q6H
£

 
> 90 mL/min:
1000 mg q6H

60 - 90 mL/min:
750 mg q8H
£

 
30 - 59 mL/min:
500 mg q6H

< 30 mL/min:
500 mg q12H
£

 
500 mg q12H
£
 
500 mg q12H, dose after dialysis on dialysis days
£


500 mg q12H
£
 
1000 mg q6H
£
 
Meropenem IV
 
1 gm q8H

Meningitis:
2 gm q8H
 
Normal
 
26 - 50 mL/min:
Usual:
1 gm q12H

Meningitis:
2 gm q12H

10 - 25 mL/min:
Usual:
500 mg q12H

Meningitis:
1 gm q12H

 
Usual:
500 mg q24H

Meningitis:
1 gm q24H
 
Usual:
500 mg q24H, dose after dialysis on dialysis days

Meningitis:
1 gm q24H, dose after dialsysis on dialysis days
 
Usual:
500 mg q24H

Meningitis:
1 gm q24H

 
Usual:
1 gm q8 - 12H

Meningitis:
2 gm q8 - 12H
Antibiotic  Dose for Normal Renal Function Dosage Adjustment For Renal Failure According to Estimated Creatinine Clearance Doses For Dialysis
> 50 mL/min  10 - 50 mL/min  < 10 mL/min  HD CAPD   CRRT
Cephalosporin

Cefazolin IV
 
1 - 2 gm q8H
(max 12 gm/day)

 
Normal
 
1 - 2 gm q12H
 
1 - 2 gm q24 - 48H
 
2 gm q48 - 72H, dose after dialysis only on dialysis days
 
0.5 gm q12H

Loading dose 2gm ¤,
1 gm q8H or 2 gm q12H

 
Cefalexine PO

 
250 - 1000 mg q6H (max 4 gm/day)

Normal 
 
250 - 1000 mg q12H 
 
125 - 500 mg q12H
 
250 mg q12 - 24H,
dose after dialysis on dialysis days

 
250 - 1000 mg q12H
 
Normal 
α
 
Cefuroxime
IV

 
750 - 1500 mg q6 - 8H
 
Normal
 
20 - 50 mL/min:
750 - 1500 mg q8H

10 - 20 mL/min:
750 - 1500 mg q12H 
¤

 
750 - 1500 mg q24H
 
750 - 1500 mg q24H, dose after dialysis on dialysis days


 
750 - 1500 mg q24H
 
750 - 1500 mg q8 - 12H
 
Cefuroxime PO
 
250 - 500 mg q12H
 
Normal
 
10 - 29 mL/min: 250 - 500 mg q12H

< 10 mL/min:
250 - 500 mg q24H

 
250 - 500 mg q48H
 
250 - 500 mg q48H, add supplemental dose 250 - 500 mg after dialysis on dialysis days
 
250 - 500 mg q24H
 
No data


 
Ceftriaxone IV

 
1 - 2 gm q12 - 24H

 
Normal
 
Normal

Normal 

Normal 
No supplemental dose necessary after dialysis

 
Normal
 
Normal
 
Cefotaxime
IV

 
Usual dose 2 gm q8H, up to 1 - 2 gm q4 - 12H


Normal 
 
1 - 2 gm q12 - 24H
 
1 - 2 gm q24H
 
1 - 2 gm q24H, dose after dialysis on dialysis days 
¤

 
0.5 - 1 gm q24H
 
1 - 2 gm q6 - 8H

Ceftazidime
IV

 
1 - 2 gm q8H
 
Normal
 
31 - 50 mL/min:
1 - 2 gm q12H

16 - 30 mL/min:
1 - 2 gm q24H
¤

 
0.5 - 1 gm q24
¤
 
1 gm q24H

or 
2 gm q48 - 72H, dose after dialysis only on dialysis days
¤

 
500 mg q24H
¤
 
1 - 2 gm q8H
¤
 
Cefoperazone
IV

 
1 - 2 gm q12H
 
Normal
 
Normal
 
Normal

Normal
No supplemental dose necessary after dialysis 


Normal 


Normal 
 
Cefepime IV
 
2 gm q8H (max dose)
 
Normal
 
30 - 60 mL/min:
2 gm q12H

11 - 29 mL/min:
2 gm q24H

 
1 gm q24H
 
1 gm q24H, add supplemental dose 1 gm after dialysis on dialysis days
 
1 - 2 gm q48H
 
2 gm q8 - 12H
¤
Antibiotic  Dose for Normal Renal Function Dosage Adjustment For Renal Failure According to Estimated Creatinine Clearance Doses For Dialysis
> 50 mL/min  10 - 50 mL/min  < 10 mL/min  HD CAPD   CRRT
Fluoroquinolone
 
Ciprofloxacin IV

 
200 - 400 mg q12H
 
Normal
 
> 30 mL/min:
Normal

5 - 29 mL/min:
200 mg q12H or 400 mg q24H 
¤

 
200 - 400 mg q24H
 
200 - 400 mg q24H, dose after dialysis on dialysis days
 
200 - 400 mg q24H 
 
200 - 400 mg q12H
 
Ciprofloxacin
PO

 
500 - 750 mg q12H
 
Normal
 
250 - 500 mg q12H
 
250 - 500 mg q24H
 
250 - 500 mg q24H, dose after dialysis on dialysis days


 
250 - 500 mg q12H
 
250 - 500 mg q12H
 
Levofloxacin
IV / PO

 
500 - 750 mg q24H
 
Normal
 
Load 500 - 750 mg,
  
then:
20 - 49 mL/min:
250 mg q24H or 750 mg q48H

10 - 19 mL/min:
250 - 500 mg q48H

 
Load 500 - 750 mg, 

then 250 - 500 mg q48H
 
Load 500 - 750 mg,

then 250 - 500 mg q48H, dose after dialysis on dialysis days
 
Load 500 - 750 mg,

then 250 - 500 mg q48H
 
Load 500 - 750 mg,

then 250 - 750 mg q24H
 
Moxifloxacin PO

 
400 mg q24H
 
Normal

Normal 
 
Normal
 
Normal
No supplemental dose necessary after dialysis

 
Normal
 
Normal
Antibiotic  Dose for Normal Renal Function Dosage Adjustment For Renal Failure According to Estimated Creatinine Clearance Doses For Dialysis
> 50 mL/min  10 - 50 mL/min  < 10 mL/min  HD CAPD   CRRT
Macrolide
 
Azithromycin IV / PO
 
500 mg q24H


 
Normal
 
Normal
 
Normal

 
Normal
No supplemental dose necessary after dialysis

 
Normal
 
Normal
 
Erythromycin PO

 
400 - 800 mg q6 - 12H
 
Normal
 
Normal
 
Normal
 
Normal
No supplemental dose necessary after dialysis

 
Normal
 
Normal
 
Clarithromycin PO
 
250 - 500 mg q12H
 
Normal
 
250 - 500 mg q24H

 
250 - 500 mg q24H
 
250 - 500 mg q24H, dose after dialysis on dialysis days


 
250 - 500 mg q24H
 
250 - 500 mg q12 - 24H
Antibiotic  Dose for Normal Renal Function Dosage Adjustment For Renal Failure According to Estimated Creatinine Clearance Doses For Dialysis
> 50 mL/min  10 - 50 mL/min  < 10 mL/min  HD CAPD   CRRT
Penicillin
 
Amoxicillin PO

 
Usual dose of 250 - 500 mg q8H, up to 1000 mg q8H

 
Normal
 
250 - 500 mg q8 - 12H
 
250 - 500 mg q24H
 
250 - 500 mg q24H, dose after dialysis on dialysis days
 
250 mg q12H
 
250 - 500 mg q8 - 12H
 
Co-amoxiclav
PO

 
625 mg q8H
 
Normal
 
250 - 500 mg (Amoxicillin component) q12H

 
250 - 500 mg (Amoxicillin component) q24H
 
250 - 500 mg (Amoxicillin component) q24H, dose after dialysis on dialysis days


 
No data

No data 
 
Co-amoxiclav IV

 
1.2 gm q8H
 
Normal

30 - 50 mL/min: Normal

10 - 30 mL/min:
1.2 gm q12H
¥
 
 
1.2 gm stat then 600 mg q24H 
£

OR
 
1.2 gm stat 600 mg q8H

OR

1.2 gm q12H 
¥

 
1.2 gm stat then 600 mg q24H, add supplemental dose 600 mg after dialysis on dialysis days

£

OR


1.2 gm q12H
 
1.2 gm stat then 600 mg q8H or 1.2 gm q12H 
¥
 
1.2 gm q8 - 12H 
¥
 
Ampicillin IV

 
1 - 2 gm q6H, up to 2 gm q4H
(max 12 gm/day)


 
Normal
 
30 - 50 mL/min:
1 - 2 gm q8H

10 - 30 mL/min:
1 - 2 gm q12H
 
1 - 2 gm q12H
 
1 - 2 gm q12H, dose after dialysis
 
500 - 1000 mg q12H
 
1 - 2 gm q6 - 8H
¤
 
Ampicillin / Sulbactam IV


Usual dose:
1.5 - 3 gm q6 - 8H

 
Normal
 
1.5 - 3 gm q8 - 12H
 
1.5 - 3 gm q12 - 24H
 
1.5 - 3 gm q12 - 24H, dose after dialysis
 
1.5 - 3 gm q12 - 24H
 
1.5 - 3 gm q6 - 8H
¤

Multidrug resistant acinetobacter:
3 gm q4H

 
Normal
 
3 gm q6H
 
3 gm q8H
 
3 gm q8H, dose after dialysis on dialysis days
 
3 gm q8H
 
3 gm q4H
 
Benzylpenicillin IV

 
1 - 4 MU q4 - 6H
¤
 
Normal
 
75% of dose q4 - 6H 
¤

 
20 - 50% of dose q4 - 6H 
¤
 
25 - 50% of dose q4 - 6H, dose after dialysis 
¤

 
25 - 50% of dose q4 - 6H 
¤
 
2 - 4 MU q4 - 6H
¤
 
Cloxacillin IV / PO

 
1 - 2 gm q4 - 6H
 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
 
Piperacillin / Tazobactam IV


4.5 gm q6H 
 
Normal
 
20 - 40 mL/min:
4.5 gm q8H

10 - 20 mL/min:
2.25 gm q6H

 
2.25 gm q6H
 
2.25 gm q8H, add supplemental dose 0.75 gm after dialysis on dialysis days
 
2.25 gm q8H
 
4.5 gm q8H
Antibiotic  Dose for Normal Renal Function Dosage Adjustment For Renal Failure According to Estimated Creatinine Clearance Doses For Dialysis
> 50 mL/min  10 - 50 mL/min  < 10 mL/min  HD CAPD   CRRT
Tetracycline

Doxycycline PO

 
100 mg q12H
 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
 
Minocycline
PO

 
LD 200 mg,
100 mg q12H
 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
Antibiotic  Dose for Normal Renal Function Dosage Adjustment For Renal Failure According to Estimated Creatinine Clearance Doses For Dialysis
> 50 mL/min  10 - 50 mL/min  < 10 mL/min  HD CAPD   CRRT
Miscellaneous
 
Clindamycin
IV / PO

 
600 mg q6 - 8H or 900 mg q8H
 
Normal
 
Normal
 
Normal
 
Normal

Normal 

Normal 
 
Colistin IV 
Ω Ψ

 
LD 9 MU, then start maintenance 4.5 MU q12H 24 hours after LD

 
Normal
 
20 - 50 mL/min:
4.5 MU q24H
< 20 mL/min:
4.5 MU q48H
 
2.5 MU q24H
 
2.5 MU q24H, add supplemental dose 0.8 MU after dialysis on dialysis days

 
No data
 
4.5 MU q12H

 
Linezolid
IV / PO

 
600 mg q12H
 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
 
Metronidazole
IV

 
500 mg q6 - 12H or 7.5 mg/kg q6H (max 4 gm/day)

 
Normal
 
Normal
 
500 mg q8 - 12H or 7.5 mg/kg q12H
 
500 mg q8 - 12H or 7.5 mg/kg q12H, dose after dialysis


 
500 mg q8 - 12H or 7.5 mg/kg q12H
 
500 mg q6 - 12H or 7.5 mg/kg q6H
 
Polymyxin B
IV

 
Loading Dose:
2.5 mg/kg STAT over 2 hours

Maintenance Dose, to start 12 hours after loading dose:
1.5 mg/kg BD, each dose over 1 hour
(Obese patient: consider using adjusted body weight)

 
Normal
 
Normal
 
Normal
 
Normal

 
Normal
 
Normal
 
Trimethoprim / Sulfamethoxazole
IV / PO

 
Treatment:
Trimethoprim component
8 - 20 mg/kg/day
divided to q6 - 12H

 
Normal

 
30 - 50 mL/min:
Normal

10 - 29 mL/min:
Trimethoprim component
2.5 - 5 mg/kg q12H

 
Use not recommended, but if required, Trimethoprim component
5 - 10 mg/kg q24H
 
Use not recommended, but if required, Trimethoprim component 
5 - 10 mg/kg q24H
 
Use not recommended, but if required, Trimethoprim component
5 - 10 mg/kg q24H
 
Trimethoprim component
5 - 10 mg/kg q12H
¤
 
Prophylaxis:
1 - 2 tabs PO q24H

 
Normal

 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
 
Vancomycin
IV

 
15 - 20 mg/kg q8 - 12H

Max 2 gm/dose

Max infusion rate: 1 gm/hour

Max dilution concentration: 1 gm/100mL

 
Normal
 
50 - 90 mL/min:
15 mg/kg q12H

15 - 49 mL/min:
15 mg/kg q24H

 
< 15 mL/min:
15 - 20 mg/kg single dose

Send random TDM sample next morning.

If TDM service not available next day, for 7.5 - 10 mg/kg single dose 24 hours after LD, then to monitor  TDM levels.


15 - 20 mg/kg single dose

Send random TDM sample next morning.

If TDM service not available next day, for 7.5 - 10 mg/kg single dose 24 hours after LD, then to monitor  TDM levels.

 
 
15 - 20 mg/kg single dose

Send random TDM sample next morning.

If TDM service not available next day, for 7.5 - 10 mg/kg single dose 24 hours after LD, then to monitor  TDM levels.
 
7.5 - 10 mg/kg q12 - 24H
Refer to pharmacy if in doubt
Antibiotic  Dose for Normal Renal Function Dosage Adjustment For Renal Failure According to Estimated Creatinine Clearance Doses For Dialysis
> 50 mL/min  10 - 50 mL/min  < 10 mL/min  HD CAPD   CRRT
Antifungal
 
Amphotericin B
IV

 
0.3 - 1 mg/kg q24H
 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
 
Fluconazole 
IV / PO

 
100 - 400 mg q24H
 
Normal
 
50 - 200 mg q24H
 
50 - 200 mg q24H
 
100 - 400 mg q48 - 72H, dose after dialysis only on dialysis days

OR

50 - 200 mg q24H, dose after dialysis on dilaysis days

 
50 - 200 mg q24H
 
200 - 400 mg q24H
 
Itroconazole PO

 
100 - 200 mg q12H (max 600 mg/day)

 
Normal
 
Normal
 
No data
 
No data

 
100 mg q12 - 24H
 
100 - 200 mg q12H
 
Voriconazole IV

 
6 mg/kg q12H for 2 doses then 4 mg/kg q12H

 
Normal
 
Not recommended
 
Not recommended
 
No data
 
No data
 
No data
 
Voriconazole PO
 
> 40 kg:
400 mg q12H for 2 doses, then 200 mg q12H

< 40 kg:
200 mg q12H then 100 mg q12H

 
Normal

 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
 
Caspofungin IV

 
70 mg on D1,
followed by 50 mg q24H

 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
Antibiotic  Dose for Normal Renal Function Dosage Adjustment For Renal Failure According to Estimated Creatinine Clearance Doses For Dialysis
> 50 mL/min  10 - 50 mL/min  < 10 mL/min  HD CAPD   CRRT
Antiparasitic
 
Pentamidine IV

 
4 mg/kg q24H
 
Normal

Normal 
 
4 mg/kg q24 - 36H

 
4 mg/kg q48H, dose after dialysis
 
4 mg/kg q24 - 36H
 
4 mg/kg q24H
Antibiotic  Dose for Normal Renal Function Dosage Adjustment For Renal Failure According to Estimated Creatinine Clearance Doses For Dialysis
> 50 mL/min  10 - 50 mL/min  < 10 mL/min  HD CAPD   CRRT
Antituberculous
 
Rifampicin PO

 
10 mg/kg q24H
 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
 
Isoniazide PO
 
5 mg/kg q24H

 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
 
Normal
 
Ethambutol PO

 
15 - 25 mg/kg q24H

 
Normal
 
30 - 50 mL/min:
15 - 25 mg/kg q24 - 36H

10 - 30 mL/min:
15 - 25 mg/kg q24 - 48H

 
15 - 25 mg/kg q48H
 
15 - 25 mg/kg q48H after dialysis
 
15 - 25 mg/kg q48H
 
15 - 25 mg/kg q24H
 
Pyrazinamide PO

 
20 - 25 mg/kg q24H (max 2.5 gm/day)


Normal 
 
< 30 mL/min: 
25 - 35 mg/kg 3x/week 
¤

 
25 - 35 mg/kg 3x/week 
¤
 
25 - 35 mg/kg 3x/week after dialysis
¤
 
20 - 25 mg/kg q24H 
¤
 
20 - 25 mg/kg q24H 
¤
Antibiotic  Dose for Normal Renal Function Dosage Adjustment For Renal Failure According to Estimated Creatinine Clearance Doses For Dialysis
> 50 mL/min  10 - 50 mL/min  < 10 mL/min  HD CAPD   CRRT
Antiviral
 
Acyclovir IV

 
5 - 10 mg/kg q8H 
¤
 
 
Normal
 
25 - 50 mL/min:
5 - 10 mg/kg q12H

10 - 25 mL/min:
5 - 10 mg/kg q24H 
¤

 
2.5 - 5 mg/kg q24H 
¤
 
2.5 - 5 mg/kg q24H, dose after dialysis 
¤
 
2.5 - 5 mg/kg q24H 
¤
 
5 - 10 mg/kg q12 - 24H 
¤
 
Acyclovir PO

 
200 - 800 mg q8H or 5 times 
¤

 
Normal
 
10 - 25 mL/min:
200 - 800 mg q8H 
¤

 
200 - 800 mg q12H 
¤
 
200 - 800 mg q12H, dose after dialysis
¤
 
200 - 800 mg q12H
¤
 
No data
 
Ganciclovir IV

 Induction Dose
 
5 mg/kg q12H

 
> 70 mL/min:
Normal

50 - 69 mL/min:
2.5 mg/kg q12H

 
25 - 49 mL/min:
2.5 mg/kg q24H

10 - 24 mL/min:
1.25 mg/kg q24H
 
1.25 mg/kg 3x/week
 
1.25 mg/kg 3x/week, dose after dialysis on dialysis days
 
1.25 mg/kg 3x/week
 
2.5 mg/kg q12H
¤
 Maintenance Dose
 
5 mg/kg q24H

 
> 70 mL/min:
Normal

50 - 69 mL/min:
2.5 mg/kg q24H

 
25 - 49 mL/min:
1.25 mg/kg q24H

10 - 24 mL/min:
0.625 mg/kg q24H
 
0.625 mg/kg 3x/week
 
0.625 mg/kg 3x/week, dose after dialysis on dialysis days
 
0.625 mg/kg 3x/week
 
2.5 mg/kg q24H
¤
 
Lamivudine PO

 
Hepatitis B:
100 mg q24H

HIV: 
150 mg q12H
or
300 mg q24H

 
Normal
 
Hepatitis B:
15 - 50 mg q24H

HIV:
50 - 150 mg q24H
 
Hepatitis B:
10 - 15 mg q24H

HIV:
25 - 50 mg q24H
 
Hepatitis B:
10 - 15 mg q24H, dose after dialysis on dialysis days

HIV:
25 - 50 mg q24H, dose after dialysis on dialysis days

 
Hepatitis B:
10 - 15 mg q24H
 

HIV:
25 - 50 mg q24H
 
100 mg first day, then 50 mg/day
 
Oseltamivir PO

 
75 mg q12H
 
Normal
 
30 - 60 mL/min:
30 mg q12H

10 - 29 mL/min:
30 mg q24H

 
No data
 
30 mg after each dialysis day, no drug on non-dialysis days.

Treatment duration not to exceed 5 days.

Assumes 3 HD session in 5 days period.

 
30 mg single dose to provide a 5-day duration
 
75 mg q12 - 24H
 
Telbivudine PO

 
600 mg q24H
 
Normal
 
30 - 49 mL/min:
600 mg q48H

10 - 29 mL/min:
600 mg q72H

 
600 mg q96H
 
600 mg q96H, dose after dialysis on dialysis days
 
No data
 
No data
 
Tenofovir PO

 
300 mg q24H
 
Normal
 
30 - 49 mL/min:
300 mg q48H

10 - 29 mL/min:
300 mg q72 - 96H

 
No data
 
300 mg after every 3rd dialysis or every 7 days if no dialysis
 
No data
 
No data
 
Tenofovir / Emtricitabine PO

 
300 / 200 mg (1 tab) q24H 
¤
 
Normal 
¤
 
30 - 49 mL/min:
1 tab q48H

< 30 mL/min:
Not recommended 
¤

 
Not recommended
¤
 
Not recommended
¤
 
Not recommended
¤
 
Not recommended
¤
 
Valacyclovir PO

 
1 gm q8H
 
Normal
 
1 gm q12 - 24H
 
500 mg q24H
 
500 mg q24H, dose after dialysis on dialysis days

 
500 mg q24H
 
1 gm q12 - 24H
 
Zidovudine PO

 
300 mg q12H
 
Normal
 
>15 mL/min:
300 mg q12H
 
< 15 mL/min:
100 mg q8H
or
300 mg q24H

 
100 mg q8H, dose after dialysis on dialysis days
 
100 mg q8H
 
300 mg q12H

Reference:
The Sanford Guide to Antimicrobial Therapy 2014
¤ Lexicomp Version 4.1.0, 2017
α Therapeutic Guideline, Antibiotic Version 14, 2010
¥ Renal Handbook
£ Product insert
Ω Garonzik et al. Population Pharmacokinetics of Colistin Methanesulfonate and Formed Colistin in Critically Ill Patients from a Multicenter Study Provide 
Dosing Suggestions for Various Categories of Patiens. Antimicrob Agents Chemother 2011 Jul;55(7):3284-94
Ψ Karvanen et al. Colistin Methanesulfonate and Colistin Pharmacokinetics in Critically Ill Patients Receiving COntinous Venovenous Hemodiafiltration.
Antimicrob Agents Chemother 2013; 57(1): 668-671