Page 293 - HPP ANTIMICROBIAL GUIDELINE 2018
P. 293

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





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