Page 294 - HPP ANTIMICROBIAL GUIDELINE 2018

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

Fluconazole 100-400mg q24h 100% 50% 50% 100% Dose AD

Flucytosine 25mg/kg q6h >40ml/min : 20-40ml/min :q12h q48h Dose AD
100%
10-20ml/min: q24h

Voriconazole IV 6mg/kg IV q12h x If CrCl <50 ml/min, accumulation of IV vehicle (cyclodextrin). Switch to PO or
2 doses. Then, 100% suspension
4mg/kg q12h (no dose adjustment).

Voriconazole PO 200mg PO q12h 100% 100% 100% No adjustment necessary

Amphotericin B (conventional) 0.5mg-1mg/kg q24h 100% 100% 100% q24h-q36h No adjustment necessary

Amphotericin B lipid complex 5mg/kg q24h 100% 100% 100% q24h-q36h No adjustment necessary

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

Pentamidine IV 4mg/kg q24h q24h q24h q24-36h 0.75gm after each Nephrotoxic
dialysis

HPP AMG Antibiotic Dosage In Patients With Impaired Renal Function 142