4.0 - Antibiotic Doses in Adults With Impaired Renal Function [updated]

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4.0 - Antibiotic Doses in Adults With Impaired Renal Function [updated]

Antibiotic	Dose for Normal Renal Function	Dosage Adjustment For Renal Failure According to Estimated Creatinine Clearance			Doses For Dialysis
Antibiotic	Dose for Normal Renal Function	> 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
Amikacin IV	15 mg/kg q24H (max 1.5 gm/day)	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					7.5 mg/kg q24H
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 ^¤
Gentamicin IV	3 - 5 mg/kg q24H (in septic shock, up to 7 mg/kg q24H) ^¤	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 ^¤				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 ^¤
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
Antibiotic	Dose for Normal Renal Function	> 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
Antibiotic	Dose for Normal Renal Function	> 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
Antibiotic	Dose for Normal Renal Function	> 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
Antibiotic	Dose for Normal Renal Function	> 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
Antibiotic	Dose for Normal Renal Function	> 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 ^¤
Ampicillin / Sulbactam IV	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
Antibiotic	Dose for Normal Renal Function	> 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
Antibiotic	Dose for Normal Renal Function	> 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 ^¤
Trimethoprim / Sulfamethoxazole IV / PO	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
Vancomycin IV		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
Antibiotic	Dose for Normal Renal Function	> 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 days OR 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
Antibiotic	Dose for Normal Renal Function	> 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
Antibiotic	Dose for Normal Renal Function	> 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
Antibiotic	Dose for Normal Renal Function	> 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 3^rd 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

Reference:

The Sanford Guide to Antimicrobial Therapy 2019

¤ UpToDate version 3.18.4-3 (15.12.2019)

α Therapeutic Guideline, Antibiotic Version 14, 2010

¥ The Renal Drug Handbook 5^th edition 2019

£ 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

ß Clinical Pharmacokinetics Pharmacy Handbook. Second edition 2019. Pharmacy Practice & development division Ministry of Health Malaysia

ṁ Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. Rybak et al. Am J Health Syst Pharm (2020)

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4.0 - Antibiotic Doses in Adults With Impaired Renal Function [updated]

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