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 Dosing
> 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)
¤ |
No data
3 - 5 mg/kg single dose and monitor serum levels ¤
|
2 - 3 mg/kg loading dose, then 1 - 2.5 mg/kg q24 - 48H
¤ |
Multiple Daily Dosing
> 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
¤ |
7.5-15 mg/kg (max 1 gm) q48 -72H, dose after dialysis only on dialysis days
¤ |
15 mg/kg (max 1 gm) 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 |
Meropenem IV |
1 gm q8H
Meningitis/CRE combination with other antibiotic:
2 gm q8H |
Normal |
26 - 50 mL/min:
Usual:
1 gm q12H
Meningitis/CRE combination
with other antibiotic:
2 gm q12H
10 - 25 mL/min:
Usual:
500 mg q12H
Meningitis/CRE combination with other antibiotic:
1 gm q12H
|
Usual:
500 mg q24H
Meningitis/CRE combination with other antibiotic:
1 gm q24H |
Usual:
500 mg q24H, dose after dialysis on dialysis days
Meningitis/CRE combination with other antibiotic:
1 gm q24H, dose after dialysis on dialysis days |
Usual:
500 mg q24H
Meningitis/CRE combination with other antibiotic:
1 gm q24H |
Usual:
1 gm q8 - 12H
Meningitis/CRE combination with other antibiotic:
500mg-1000mg 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 |
>35ml/min:
1 - 2 gm q8H
11-34ml/min:
0.5 – 1 gm q12H
|
0.5 – 1 gm q24H |
2 gm after dialysis if next
dialysis expected in 48 hours, and 3 gm after dialysis is expected in 72 hours
OR
1 gm q24H
OR
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 |
250 - 500 mg q12H |
250-500 mg q12H,
give one of the dialysis day doses after dialysis
|
500mg-1000mg q12H |
No data
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 q24H
OR
Normal
¥
|
250 - 500 mg q48H
OR
Normal
¥ |
250 - 500 mg q48H, add supplemental dose 250 - 500 mg after dialysis on dialysis days
OR
Normal
¥ |
No data¤OR
Normal
¥ |
No data
|
Ceftriaxone IV
|
1 - 2 gm q12 - 24H
|
Normal |
Normal |
Normal |
Normal
No supplemental dose necessary after dialysis
|
Normal |
Normal |
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 q24H
¤ |
0.5-1 gm q24H
or
2 gm q48 - 72H, dose after dialysis only on dialysis days
¤
|
1gm 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
¤
|
200mg q12H or 400 mg q24H¤ |
200 mg q12H or 400 mg q24H,
dose after dialysis on dialysis days¤ |
200mg q12H ¥ |
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 q24H ¤250mg q8-12H ¥ |
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 |
> 30 mL/min:
Normal
¤
<30 ml/min:
500 mg q24H
|
500 mg q24H |
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 |
> 30 mL/min:
Normal
¤
<30 ml/min:
250 - 500 mg q12H
|
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 q8-12H
Deep seated infection:
1g q12-8H (875/125mg) |
Normal |
> 30 mL/min:
Normal
<30 ml/min:
625 mg q12-24H
¤
> 30 mL/min:
Normal
<30 ml/min:
contraindicated to use 1g formulation
|
250 - 500 mg (Amoxicillin component) q24H
625 mg q24H
contraindicated to use 1g formulation |
625 mg q24H, dose after dialysis on dialysis days
contraindicated to use 1g formulation
|
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 q12H
¥
OR
1.2 gm stat then 600 mg q24H
£
OR
1.2 gm stat then 600 mg q8H
¥
|
1.2 gm q12H
¥
OR
1.2 gm stat then 600 mg q24H, add supplemental dose 600 mg after
dialysis on dialysis days
£
|
1.2 gm q12H
¥
OR
1.2 gm stat then 600 mg q24H
£
OR
1.2 gm stat then 600 mg q8H
¥ |
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 q6-8H
10 - 30 mL/min:
1 - 2 gm q8-12H |
1 - 2 gm q12H |
1 - 2 gm q12H, dose after dialysis on dialysis days |
500 - 1000 mg q12H |
1 - 2 gm q6 - 8H
¤ |
Ampicillin / Sulbactam IV
|
Usual dose:
1.5 - 3 gm q6 - 8H
|
Normal |
>30 mL/min:
Normal
15-29 mL/min:
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 q3-4H
|
Normal |
>30 mL/min:
Normal
15-29 mL/min:
3 gm q4-6H
|
3 gm q6-8H |
3 gm q6-8H, dose after dialysis on dialysis days |
3 gm q6-8H |
3 gm q3-4H |
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 (based on IBW)
>75kg-9 MU
61-74kg- 8MU
51-60kg- 7MU
<50kg- 6MU
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
If loading dose required,
20mg/kg single dose (Max 2 gm/dose)
Max infusion rate: 1 gm/hour
Max dilution concentration: 1 gm/100mL
|
>60 ml/min >90kg :1000mg q8H
75-89kg :750mg q8H
60-74kg :1000mg q12H
50-59kg :750mg q12H
30-49kg :500mg q12H |
40-59 ml/min
>90kg :750mg q12H 75-89kg :750mg q12H 60-74kg :500mg q12H 50-59kg :750mg q24H 30-49kg :500mg q24H
20-39 ml/min >90kg :750mg q24H 75-89kg :750mg q24H 60-74kg :500mg q24H 50-59kg :500mg q24H 30-49kg :500mg q24H
|
<20 ml/min
Loading dose 20mg/kg single dose (Max 2 gm/dose), then send
random TDM sample next morning
If TDM is not available the next day, give 7.5-10mg/kg stat dose
24 hours after loading dose. Send random TDM sample next working day. |
Loading
dose, 20mg/kg single dose (Max 2 gm/dose), then send random TDM sample next
morning.
If
TDM is not available the next day, give 7.5-10mg/kg stat dose 24 hours after
loading dose. Send random TDM sample next working day.
ß
|
Loading
dose, 20mg/kg single dose (Max 2 gm/dose), then send random TDM sample next working
day
ß |
20 –
25mg/kg (Max 2 gm/ dose) loading dose, then 7.5 - 10 mg/kg q12 - 24H
ṁ |
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 deoxycholate
IV
|
0.3 - 1 mg/kg q24H |
Normal |
Normal |
Normal |
Normal |
Normal |
Normal |
Amphotericin B lipid
complex IV
| 5mg/kg q24H | Normal | Normal | Normal | Normal | Normal | Normal |
Fluconazole
IV / PO
|
100 - 400 mg q24H |
Normal |
50 - 200 mg q24H
|
50 - 200 mg q24H |
50 - 200 mg q24H, dose after dialysis on dialysis daysOR
100 - 400 mg q48 - 72H, dose after dialysis
|
50 - 200 mg q24H |
200 - 400 mg q24H |
Itraconazole 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 due to accumulation of IV vehicle (cyclodextrin), oral route preferred |
Not recommended due to accumulation of IV vehicle (cyclodextrin), oral route preferred
|
No data. Oral route preferred |
No data. Oral route preferred |
No data. Oral route preferred |
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 |
Micafungin IV
|
100mg q24H
|
Normal |
Normal |
Normal |
Normal |
Normal |
150-200mg q24H |
Flucytosine PO
| 25mg/kg q6H | 25mg/kg q6H | 25mg/kg q12H | 25mg/kg q24H | 25mg/kg q24H | 0.5 – 1 gram q24H | 25mg/kg q12H
|
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 mL/min:
15 - 25 mg/kg q24H
10 - 30 mL/min:
20 - 25 mg/kg 3x/week
¤ |
20 - 25 mg/kg 3x/week
¤ |
20 - 25 mg/kg 3x/week after dialysis on dialysis days
¤ |
20 - 25 mg/kg 3x/week
¤ |
15 - 25 mg/kg q24H |
Pyrazinamide PO
|
20 - 25 mg/kg q24H (max 2.5 gm/day)
|
Normal |
>30 mL/min:
20 - 25 mg/kg q24H
< 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 |
>25mL/min:
Normal
10 - 25 mL/min:
200 - 800 mg q8H
¤
|
200 - 800 mg q12H
¤ |
200 - 800 mg q12H, dose
after dialysis on dialysis days
¤ |
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 |
30 -49mL/min:
Hepatitis B: 100mg stat then 50 mg q24H
HIV: 150 mg q24H
15-29mL/min:
Hepatitis B:
100mg stat then 25 mg q24H
HIV:
150 mg stat then 100 mg q24H
5-14mL/min:
Hepatitis B:
35mg stat then 15 mg q24H
HIV:
150 mg stat then 50mg q24H
|
<5 mL/min:
Hepatitis B:
35mg stat then 10 mg q24H
HIV:
50 mg stat then 25 mg q24H |
Hepatitis B:
35 mg stat then 10 mg q24H, dose after
dialysis on dialysis days
HIV:
50 mg stat then 25 mg q24H, dose after dialysis on dialysis days
|
Hepatitis B:
35mg stat then 10 mg q24H
HIV:
50 mg stat then 25 mg q24H |
100 mg stat then then 50 mg
q24H |
Oseltamivir PO
|
75 mg q12H |
Normal |
30 - 60 mL/min:
30 mg q12H
10 - 29 mL/min:
30 mg q24H
|
75mg single dose ¥ |
30 mg stat then 30 mg after each dialysis day, no drug on
non-dialysis days.
Treatment duration not to exceed 5 days.
Assumes 3 HD sessions in 5 days period.
¥
|
30 mg single dose to provide a 5-day duration |
75mg q24H or 30mg q12H ¥ |
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
¤ |
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 |