Page 297 - HPP ANTIMICROBIAL GUIDELINE 2018

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

Acyclovir IV 5-10mg/kg q8h 100% q8h 30-50ml/min: q12h 50% q24h Dose AD Rapid IV infusion
can cause renal
10-30ml/min: q24h failure.

Ganciclovir IV Induction: 5mg/kg q12h 2.5mg/kg q12h CrCl 25-49: 2.5mg/kg q24h 1.25mg/kg 3x/wk Dose AD

CrCl 10-24: 1.25mg/kg q24h

Maintenance 5mg/kg q24h 2.5mg/kg q24h CrCl 25-49: 2.5mg/kg q24h 0.625mg/kg 3x/wk 0.625mg/kg
3x/wk AD
CrCl 10-24: 1.25mg/kg q24h

Valganciclovir Induction: 900mg q12h 450mg q12h CrCl 25-39: 450mg q24h Avoid
(use adjusted dose
CrCl 10-24: 450mg q48h of ganciclovir)

Maintenance: 900mg q24h 450mg q24h CrCl 25-39: 450mg q48h Avoid
(use adjusted dose
CrCl 10-24: 450mg 2x/wk of ganciclovir)

AD = after dialysis. “Dose AD” refers only to timing of dose with NO extra drug
D = dosage reduction, I = interval extension, SGC=Soft gel capsule, HD – Hemodialysis, PD – Peritoneal dialysis

HPP AMG Antibiotic Dosage In Patients With Impaired Renal Function 143