Page 292 - HPP ANTIMICROBIAL GUIDELINE 2018

ADJUSTMENT FOR RENAL FAILURE
DOSE FOR NORMAL SUPPLEMENT
ANTIMICROBIAL Estimated creatinine clearance (CrCl), ml/min COMMENTS
RENAL FUNCTION FOR DIALYSIS
> 50 10-50 < 10

Penicillins

Amoxicillin (oral) 250-500mg q8h 100% q8-12h q24h Dose AD

Ampicillin 250mg-2gm q6h 100% q6-12h q12-24h Dose AD

Amoxicillin/clavulanate (oral) 500/125mg q8h 100% q12h q24h extra dose after
dialysis

Amoxicillin/clavulanate (IV) 1.2g q8h 100% 10-30ml/min: 100% q24h extra dose after
100% q12h dialysis

Ampicillin/sulbactam (IV) 1.5g-3g q6h 100% 15-29ml/min : <15ml/min : Dose AD
100% q12h 100% q24h

Benzylpenicillin 0.5-4 million U q4-6h 100% 75% 20-50% Dose AD

Piperacillin/tazobactam 4.5gm q6 -8h 100% 2.25gm q6h 2.25g q8h extra
(q8h if <20) 1.125g after HD

Tetracycline

Tetracycline 250-500mg q6-12h q8-12h q12-24h q24h None Avoid in ESRD

HPP AMG Antibiotic Dosage In Patients With Impaired Renal Function 141