University of Pennsylvania Medical Center Guidelines for Antibiotic Use

 

ANTIBIOTIC DOSING IN RENAL IMPAIRMENT1

 

DRUG NAME USUAL DOSE (Normal renal function) CrCl (ml/min) DOSAGE ADJUSTMENT (in renal insufficiency)
ABACAVIR 300 mg PO q12h no change no change

ABACAVIR/LAMIVUDINE

(EPZICOM)

 1 tablet PO q24h not recommended in fixed combination for Clcr < 50 ml/min
ACYCLOVIR 5 - 10 mg/kg IV q8h > 50 5 - 10 mg/kg IV q8h
25-50 5- 10 mg/kg IV q12h
10-24 5 - 10 mg/kg IV q24h
0-9 2.5 -5 mg/kg IV q24h
HD 2.5 - 5 mg/kg IV q24h (give dose after dialysis on dialysis days)
200 mg PO q4h (5x daily) > 10 no adjustment necessary
0-10 200 mg PO q12h
400 mg PO q4 (5x daily) - 12h >10 no adjustment necessary
0-10 200 - 400 mg PO q12h
800 mg PO q4 (5x daily) - 12h > 25 no adjustment necessary
10-25 800 mg PO q8 - 12h
0-9 400 - 800 mg PO q12h
HD 800 mg PO q12h (give dose after dialysis on dialysis days)
ADEFOVIR 10 mg PO daily > 50 normal dose
20 - 49 10 mg PO q48h
10-19 10 mg PO q72h
HD 10 mg PO every 7 days following dialysis

ANTIBIOTIC DOSING IN RENAL IMPAIRMENT

DRUG NAME USUAL DOSE (Normal renal function) CrCl (ml/min) DOSAGE ADJUSTMENT (in renal insufficiency)
AMINOGLYCOSIDES (gentamicin, netilmicin, tobramycin, amikacin) Refer to aminoglycoside dosing page by clicking here
AMOXICILLIN 500 mg - 1 gm  PO q12h > 30 no dose adjustment necessary
10 - 30 250 - 875 mg PO q12h
<10 250 - 875 mg PO q24h
HD 250 - 875 mg PO q24h + 250 - 500 mg after each HD
AMOXICILLIN + CLAVULANATE 500 - 875 mg PO q12h >15 normal dose and interval
5 - 15 500 - 875 mg q24h
< 5 250 - 500 mg q24h
HD 250 - 500 mg q24h + 250 - 500mg after each HD
AMPHOTERICIN B 0.25 - 1.5 mg/kg/day

* not to exceed total daily dose of 1.5 mg/kg

no dose change necessary Refer to TableVIII  for dosing guidelines.
AMPICILLIN 250 mg - 2 gm IV q4-6h > 30 no dose adjustment necessary
10 - 30 normal dose q6 - 8h
< 10 normal dose q8h
HD normal dose q8h + supplemental dose after each HD
AMPICILLIN / SULBACTAM

1.5 - 3 gms IV q6h > 30 normal dose IV q6h
15-30 normal dose IV q12h
< 15 normal dose IV q24h
HD normal dose q24h + supplemental dose after each HD

 

<
DRUG DOSE USUAL DOSE (Normal renal function) CrCl (ml/min) DOSAGE ADJUSTMENT (in renal insufficiency)
AMPRENAVIR

1200 mg PO q12h (capsule)

1400 mg PO q12h (oral solution)

 no change no change
ATAZANAVIR 400 mg PO q24h no change no change
AZITHROMYCIN 500 mg IV/PO once daily for 3 days no change no change
AZTREONAM 1 - 2 gms IV q8h > 30 normal dose
10 - 30 load with 1-2 gm, then 500 mg - 1 gm IV q8h
<10 load with 1-2 gm, then 250 - 500 mg IV q8h
HD dose for CrCl < 10 + supplemental dose after HD
CEFADROXIL 1-2 gm/day in single or divided doses (500mg - 1 g PO BID) > 50 no dose adjustment necessary
25-50 1 gm x 1, then 500 mg po BID
10-25 1 gm x 1, then 500 mg po Q 24 h
<10 1 gm x 1, then 500 mg po Q 36 h
HD 500 mg- 1 gm po after each hemodialysis
CEFAZOLIN 500 mg - 1 gm IV q8h > 35 no dose adjustment necessary
10 - 35 500 mg - 1 gm q12h
< 10 500 mg - 1 gm q24h
HD 2 gm after each HD
CEFEPIME 1 - 2 gm IV q12h > 60 no dose adjustment necessary
  30 - 60 1 - 2 gm q 24h
11 - 29 500 mg - 1 gm q24h
< 11 250 - 500 mg q24h
HD dose for CrCl < 11 + 250 - 500 mg after each HD
2 gm IV q8h (meningitis) > 60 no dose adjustment necessary
  30-60 2 gm IV q12h
11 - 29 2 gm IV q24h
< 11 1 gm IV q24h
HD dose for CrCl < 11 + 1 gm after each HD
1 gm IV q8h (neutropenic fever) > 60 no dose adjustment necessary
30 - 60 1 gm IV q12h
11 - 29 1 gm IV q24h
< 11 500 mg IV q24h
HD dose for CrCl < 11 + 500 mg after each HD

ANTIBIOTIC DOSING IN RENAL IMPAIRMENT

DRUG NAME USUAL DOSE (Normal renal function) CrCl (ml/min) DOSE ADJUSTMENT (in renal insufficiency)
CEFTRIAXONE 1 - 2 gms IV q24h

* max. dose = 4 gm/day		 no change * adults with both renal and hepatic failure should not receive more than 2 gm/day
CEFUROXIME AXETIL 250 - 500 mg PO q12h > 10 normal dose
< 10 250 mg PO q24h
CEPHALEXIN 250 - 500 mg PO q6h > 40 normal dose
11 - 40 250 - 500 mg PO q8 - 12h
5-10 250 - 500 mg PO q12h
< 10 250 - 500 mg PO q12 - 24h
CHLORAMPHENICOL 50 mg/kg/d IV in 3-4 divided doses (some infections may require higher doses) Dosage adjustment is required with hepatic dysfunction and severe renal dysfunction. Click this link for more detailed information
CIDOFOVIR 5 mg/kg IV q 2 weeks Use CONTRAINDICATED with a Scr >1.5 mg/dl or Clcr < 55 ml/min or proteinuria > 2+ (100 mg/dL)
CLARITHROMYCIN 250 - 500 mg PO q12h > 30 normal dose
< 30 If normal dose is 500 mg PO q12h: give load of 500 mg then 250 mg q12h

If normal dose is 250 mg PO q12h, give 250 mg q24h
CLINDAMYCIN 600 mg IV q8h    OR                                  150 - 450 mg PO q6h no change no change
COLISTIN METHANE SULPHONATE   sCR<1.3 5 mg/kg/day in 2-4 divided doses
sCR 1.3-1.5 2.5-3.8 mg/kg/day divided Q12 hr
sCR 1.6 -2.5 2.5 mg/kg/day divided Q12-Q24
sCR >2.5 2.25 mg/ Q36 hrs
CrCl <10 ml/min or anuric 2-3 mg/kg Q 3 days
Hemodial 2-3 mg/kg IV post hemodialysis
DARUNAVIR 600 mg PO no change no change
DICLOXACILLIN 125 - 500 mg PO q6h no change no change

 

ANTIBIOTIC DOSING IN RENAL IMPAIRMENT

TR>TR> TR>
DRUG NAME USUAL DOSE (Normal renal function) CrCl (ml/min) DOSAGE ADJUSTMENT (in renal insufficiency)
DIDANOSINE (ddI) > 60 kg: 200 mg PO q12h       OR

400 mg PO q24h (tablets)

<60kg: 125 mg PO q12h       OR

250 mg PO q24h (tablets)

> 50 > 60 kg:  normal dose

< 60 kg:  normal dose

26 - 49 > 60 kg:  100 mg PO q12h or 200 mg PO q24h (tablets)

< 60 kg:  75 mg PO q12h or 150 mg PO q24h (tablets)       

10 - 25 > 60 kg:  150 mg PO q24h (tablet)

< 60 kg:  100 mg PO q24h (tablet) 

< 10 > 60 kg:  100 mg PO q24h (tablet)

< 60 kg:  75 mg PO q24h (tablet)

HD dose for CrCl < 10
DOXYCYCLINE 100 mg IV/PO q12h no change no change
EFAVIRENZ 600 mg PO q24h no change no change
EMTRICITABINE 200 mg PO q24h > 50 no dose adjustment necessary
30-49 200 mg PO q48h
15-29 200 mg PO q72h
<15 200 mg PO q96h
HD 200 mg PO q96h-if dose is due on day of dialysis, give dose post-dialysis

EMTRICITABINE/TENOFOVIR

(TRUVADA)

1 tablet PO q24h > 50 normal dose
30-49 1 tablet PO q48h
<30 not recommended in fixed combination

EMTRICITABINE/TENOFOVIR/ EFAVIRENZ (ATRIPLA)

1 tablet PO q24h not recommended in fixed combination for Clcr < 50 ml/min
ENFUVIRTIDE 90 mg SQ q12h no change no change
ENTECAVIR 0.5-1 mg PO q24h > 50 no dose adjustment necessary
30-50 0.25-0.5 mg PO q24h
10-30 0.15-0.3 mg PO q24h
<10 0.05-0.1 mg PO q24h
HD 0.05-0.1 mg daily given after dialysis on dialysis days
ERYTHROMYCIN 250 - 500 mg PO q6 - 12h   OR
15 - 20 mg/kg/day IV divided q6h		 no change no change
ETHAMBUTOL 15 - 25 mg/kg/day > 50 normal dose
10 - 50 normal dose q24 - 36h
< 10 normal dose q48h
HD normal dose after each HD
FLUCONAZOLE Loading Dose:  100 - 800 mg PO/IV q24h

Maintenance Dose:  50 - 800 mg PO/IV q24h

> 50 normal dose
< 50 (no HD) 50% normal dose q24h
HD load with 100 - 400 mg,  then normal dose after each HD
FLUCYTOSINE (5-FC) 50 - 150 mg/kg/day PO divided q6h > 40 normal dose
20 - 40 12.5 - 37.5 mg/kg q12h
10-20 12.5 - 37.5 mg/kg q24h
< 10 12.5 - 37.5 mg/kg q24 - 48h
HD If receiving HD q 48 - 72h then 20 - 50 mg/kg immediately after each HD

 

ANTIBIOTIC DOSING IN RENAL IMPAIRMENT

DRUG NAME USUAL DOSE (Normal renal function) CrCl (ml/min) DOSE ADJUSTMENT (in renal insufficiency)
FOSAMPRENAVIR 1400 mg po twice daily (note dosing differs when combined with ritonavir) not cleared by kidneys none needed
FOSCARNET Induction for CMV: 60 mg/kg IV q8h  OR    90 mg/kg q12h   (infuse over 1 hour)

*IV hydration is recommended to reduce the risk of renal toxicity

> 1.4 ml/min/kg 60 mg/kg q8h 90 mg/kg q12h
> 1 - 1.4 ml/min/kg 45 mg/kg q8h 70 mg/kg q12h
> 0.8 - 1 ml/min/kg 50 mg/kg q12h 50 mg/kg q12h
> 0.6 - 0.8 ml/min/kg 40 mg/kg q12h 80 mg/kg q24h
> 0.5 - 0.6 ml/min/kg 60 mg/kg q24h 60 mg/kg q24h
> 0.4 - 0.5 ml/min/kg 50 mg/kg q24h 50 mg/kg q24h
< 0.4 ml/min/kg not recommended not recommended
Maintenance for CMV:  90 mg/kg IV q24h    OR 120 mg/kg IV q24h    (infuse over 2 hours)

*IV hydration is recommended to reduce the risk of renal toxicity

> 1.4 ml/min/kg 90 mg/kg q24h 120 mg/kg q24h
> 1 - 1.4 ml/min/kg 70 mg/kg q24h 90 mg/kg q24h
> 0.8 - 1 ml/min/kg 50 mg/kg q24h 65 mg/kg q24h
> 0.6 - 0.8 ml/min/kg 80 mg/kg q48h 105 mg/kg q48h
> 0.5 - 0.6 ml/min/kg 60 mg/kg q48h 80 mg/kg q48h
> 0.4 - 0.5 ml/min/kg 50 mg/kg q48h 65 mg/kg q48h
< 0.4 ml/min/kg not recommended not recommended
FOSCARNET Induction for HSV:  40 mg/kg IV q12h   OR    40 mg/kg IV q8h > 1.4 ml/min/kg 40 mg/kg q12h 40 mg/kg q8h
> 1 - 1.4 ml/min/kg 30 mg/kg q12h 30 mg/kg q8h
> 0.8 - 1 ml/min/kg 20 mg/kg q12h 35 mg/kg q12h
> 0.6 - 0.8 ml/min/kg 35 mg/kg q24h 25 mg/kg q12h
> 0.5 - 0.6 ml/min/kg 25 mg/kg q24h 40 mg/kg q24h
> 0.4 - 0.5 ml/min/kg 20 mg/kg q24h 35 mg/kg q24h
< 0.4 not recommended not recommended
GANCICLOVIR IV Induction: 5 mg/kg IV q12h x 14 - 21 days >70 5 mg/kg q12h
  50-69 2.5 mg/kg q12h
25-49 2.5 mg/kg q24h
<25 1.25 mg/kg q24h
HD 1.25 mg/kg 3x/week with doses given after HD
Maintenance: 5 mg/kg IV q24h >70 5 mg/kg q24h
  50-69 2.5 mg/kg q24h
25-49 1.25 mg/kg q24h
<25 0.625 mg/kg q24h
HD 0.625 mg/kg 3x/week with doses given after HD

 

DRUG NAME USUAL DOSE (Normal renal function) CrCl (ml/min) DOSAGE ADJUSTMENT (in renal insufficiency)
GANCICLOVIR PO 1 gm PO q8h OR  500mg PO q3h, 6x/day > 70 normal dose
50 - 69 1.5 gm PO qd or 500 mg PO q8h
25 - 49 1 gm PO qd or 500 mg PO q12h
10 - 24 500 mg PO qd
< 10 500 mg PO 3x/week
HD dose for CrCl < 10, doses given after HD
IMIPENEM

(Refer to product information for complete prescribing information for patients requiring different total daily doses)		 500 mg IV q6h (2 g/day) [ Note that meningitis dose is higher (up to 1g q 6h, depending on renal function- consult ID)] > 71

> 70 kg:            500 mg q6h

60 - 69 kg:        500 mg q8h

50 - 59 kg:        250 mg q6h

40 - 49 kg:        250 mg q6h

30 - 39 kg:        250 mg q8h

41 - 70 > 70 kg:            500 mg q8h

60 - 69 kg:        250 mg q6h

50 - 59 kg:        250 mg q6h

40 - 49 kg:        250 mg q8h

30 - 39 kg:        125 mg q6h

21 - 40 > 70 kg:            250 mg q6h

60 - 69 kg:        250 mg q8h

50 - 59 kg:        250 mg q8h

40 - 49 kg:        250 mg q12h

30 - 39 kg:        125 mg q8h

6 - 20 > 70 kg:            250 mg q12h

60 - 69 kg:        250 mg q12h

50 - 59 kg:        250 mg q12h

40 - 49 kg:        250 mg q12h

30 - 39 kg:        125 mg q12h

**In patients undergoing hemodialysis or with a Clcr of 6-20 ml/min, the 500mg IV q 12 hour dose should be reserved for treatment of severe infections. Patients with Clcr < 5 ml/min should not receive imipenem/cilastatin unless dialysis is going to be instituted within 48 hours.   These patients may be at an increased risk of seizures.
INDINAVIR 800 mg PO q 8h no change no change
ISONIAZID 300 mg PO daily no change no change
ITRACONAZOLE 100 - 200 mg PO (capsule / solution) q12h              OR

200 mg IV q12h x 4 doses, then 200 mg IV q24h

***IV use NOT TO EXCEED 14 days***

PO:  no change              PO: no change
IV:  > 30 normal dose
IV:  < 30 not recommended due to injectable excipient
LAMIVUDINE (Epivir formulation) 150 mg po q 12h > 50 150 mg PO q12h
30-49 150 mg PO q24h
15-29 150 mg x 1,then 100 mg PO q24h
5 - 14 150 mg x 1, then 50 mg PO q24h
< 5 150 mg x 1, then 25 mg PO q24h
HD 150 mg x 1, then 25 - 50 mg PO q24h
Lamivudine (Epivir-HBV formulation) 100 mg orally once daily > 50 100 mg once daily
30-49 100 mg x 1 day, then 50 mg daily afterwards
15-29 100 mg x 1 day, then 25 mg daily afterwards
5-14 35 mg x 1 day, then 15 mg daily afterwards
<5 & HD 35 mg x 1 day, then 10 mg daily afterwards
LAMIVUDINE/ZIDOVUDINE (COMBIVIR) 1 tablet PO q12h not recommended in fixed combination for Clcr < 50 ml/min
LEVOFLOXACIN If  normal dose 250 mg IV/PO q24h > 20 250 mg q24h
< 20 and HD 250 mg q48h
If normal dose 500 mg IV/PO q24h > 50 500 mg q24h
20 - 49 500 mg q48h
< 20 and HD 500 mg x 1, then 250 mg q48h
CVVHD 500 mg q 48h
If normal dose 750 mg IV/POq24 h (note that the 500 mg q 24h dosage schedule shown above should be used if the levofloxacin MIC is <0.5 ug/ml) > 50 750 mg q24h
20 - 49 750 mg q48h
< 20 and HD 750 mg X 1, then 500 mg q48h
CVVHD 750 mg q 48h
LINEZOLID 600 mg IV/PO q12h no change no change
MEROPENEM 1 gm IV q 8h - (note that meningitis dose is higher, 2g q 8h, with normal renal function) >50 normal dose
26-50 normal dose q12h
10-25 50% normal dose q12h
<10 50% normal dose q24h
HD 50% normal dose q24h + 50% normal dose after each HD
METRONIDAZOLE 500 mg IV/PO q12h no change no change
500 mg IV/PO q8h  (C. difficile diarrhea) no change no change

 

ANTIBIOTIC DOSING IN RENAL IMPAIRMENT

DRUG NAME USUAL DOSE (Normal renal function) CrCl (ml/min) DOSE ADJUSTMENT (in renal insufficiency)
NAFCILLIN 2 gm IV q4-6h no change no change
NELFINAVIR 1250 mg PO q12h no change no change
NEVIRAPINE 200 mg PO q12h no change no change
NITROFURANTOIN 50-100 mg PO q12h > 40 normal dose
< 40 avoid use: therapeutic levels not attained in the urine
NORFLOXACIN 400 mg PO q12h > 30 normal dose
< 30 normal dose PO q24h
PENICILLIN G

2.0 - 4.0 million units IV q4h

 > 125 3.0 - 4.0 million units q4h
60 - 124 1.8 - 2.0 million units q4h
40 - 59 1.3 - 1.5 million units q4h
20 - 39 800,000 - 1.0 million units q4h
10 - 19 800,000 - 1.0 million units q6h
< 10 & HD 500,000 - 800,000 units q6h
< 10 & ESLD 500,000 units q8h
PENTAMIDINE

4 mg/kg IV or IM q24h

> 50 normal dose
10-50 normal dose q24-36h
< 10 normal dose q48h
HD dose for CrCL < 10 ml/min
PIPERACILLIN 3-4 gm IV q6h (non-P. aeruginosa) >40 normal dose
20-40 3-4 gm IV q8h
<20 3-4 gm IV q12h
HD 2 gm IV q8h + 1 gm supplemental dose after each HD
Pseudomonas aeruginosa infections*: 3 gm IV q4h. * Combination therapy with an aminoglycoside may be indicated, depending on piperacillin MIC and site of infection. Treatment of uncomplicated UTIs can be with "non-P. aeruginosa " dosages shown above >40 normal dose
20-40 3 gm IV q6h
<20 3 gm IV q8h
HD 2 gm q8h + 1 gm supplemental dose after each HD
PIPERACILLIN/TAZOBACTAM Mild to Moderate Infections :4.5 gm IV q8h >40 normal dose
20-40 2.25 gm q6h
<20 2.25 gm q8h
HD 2.25 gm q8h + 1.125 gm supplemental dose after each HD
Severe/life threatening infections: 4.5 gm IV q6h >40 normal dose
20-40 4.5 gm q8h
<20 4.5 gm q12h
HD 2.25 gm q8h + 1.125 gm supplemental dose after each HD
Pseudomonas aeruginosa infections*: 3.375 gm IV q4h. * Combination therapy with an aminoglycoside may be indicated, depending on piperacillin MIC and site of infection. Treatment of uncomplicated UTIs can be with "mild to moderate infection" dosages >40 normal dose
20-40 3.375 gm q6h
<20 3.375 gm q8h
HD 2.25 gm q8h + 1.125 gm supplemental dose after each HD

ANTIBIOTIC DOSING IN RENAL IMPAIRMENT

DRUG NAME USUAL DOSE (Normal renal function) CrCl (ml/min) DOSE ADJUSTMENT (in renal insufficiency)
POSACONAZOLE 200 mg q6h or 400 mg PO q12h no change no change
PYRAZINAMIDE

15-30 mg/kg/d (maximum 2 gm/day)

> 10 normal dose
<10 25-30 mg/kg three times weekly
HD 25-30 mg/kg three times weekly, post-dialysis
PYRIMETHAMINE 25 - 75 mg PO q24h no change no change
QUINUPRISTIN/DALFOPRISTIN 7.5 mg/kg IV q8h no change no change
RIFABUTIN 300 mg PO q24h no change no change
RIFAMPIN 600 mg IV/PO q12 - 24h no change no change
RITONAVIR 600 mg PO q12h no change no change
SAQUINAVIR 1000 mg PO q12h plus ritonavir 100 mg PO q12h no change no change
STAVUDINE > 60kg: 40 mg PO q12h

< 60kg: 30 mg PO q12h

> 50 normal dose
26-49 normal dose q24h
< 25 and HD 50% normal dose q24h
STREPTOMYCIN 15 mg/kg/day IM > 80 normal dose
50-80 1 gram loading dose, then 7.5 mg/kg q24h
10-49 1 gram loading dose, then 7.5 mg/kg q24-72h
< 10 7.5 mg/kg q72-96h
HD give 50-75% of loading dose after each HD
SULFADIAZINE 500 mg - 2 gms PO q6h no change no change
TELBIVUDINE 600 mg PO q24h > 50 normal dose
30 - 49 600 mg PO q48h
< 30 600 mg PO q72h
ESRD or HD 600 mg PO q96h
TENOFOVIR 300 mg po q24h >49 normal dose
30-49 normal dose q 48h
10-29 normal dose twice weekly
<10, not on HD consult Antibiotic Management 215 3060336
HD normal dose weekly, assuming thrice weekly HD
TETRACYCLINE 250 - 500 mg PO q6h > 50 normal dose q8-12h
10-49 normal dose q12-24h
< 10 normal dose q24h
TIGECYCLINE 100 mg x 1 then 50 mg IV Q 12 hr NA no adjustment needed for renal insufficiency

 

ANTIBIOTIC DOSING IN RENAL IMPAIRMENT

DRUG NAME USUAL DOSE (Normal renal function) CrCl (ml/min) DOSE ADJUSTMENT (in renal insufficiency)
TMP/SMX

(Bactrim, Septra)

1SS tablet = 80 mg TMP;

1DS tablet =160 mg TMP;

1 ampule(5 ml) = 80 mg TMP

Urinary Tract Infections:

5 mg/kg/day of trimethoprim component given in divided doses

Serious Systemic Infections:

8-10 mg/kg/day of trimethoprim component given in divided doses (q 6 -12hr)

Pneumocystis carinii Pneumonia

15-20 mg/kg/day of trimethoprim component given q 6-8hr

> 30 normal dose
15 - 30 normal dose divided q12h x 48-72h then 50% of normal daily dose given q24h
< 15 NOT ADVISED-consult Antibiotic Management 215 3060336
HD NOT ADVISED-consult Antibiotic Management 215 3060336
VALACYCLOVIR Primary Genital Herpes Simplex 1 gm PO q12hrs > 30 normal dose
10-29 1 g q24 hrs
<10 500 mg q24 hrs
HD 500 mg q24 hrs dosed post-dialysis
Recurrent Herpes Simplex (genital) 500 mg PO q12h > 30 normal dose
< 29 500 mg PO q24h
HD dose for Clcr < 29, given after HD
Herpes zoster: 1 gm PO q8h > 50 normal dose
30-49 1 gm PO q12h
10-29 1 gm PO q24h
<10 500 mg PO q24h
HD dose for Clcr < 10, given after HD
VALGANCICLOVIR 900 mg po q12h   INDUCTION MAINTENANCE
> 60 900 mg po q12h 900 mg po q24h
40 - 59 450 mg po q12h 450 mg po q24h
25 - 39 450 mg po q24h 450 mg po q2days
10 - 24 450 mg po q2days 450 mg po twice weekly
HD do not use in patients on hemodialysis
VANCOMYCIN Refer to vancomycin dosing recommendation page by clicking here
ZIDOVUDINE 200 mg PO q8h > 26 normal dose
< 25 and HD 100 mg q8h

1Recommendations adapted from pharmaceutical company product information; McEvoy GK, ed. AmericanHospital Formulary Service-2001. Bethesda: American Society of Health-Systems Pharmacists, 2001:49-858;Aronoff GR, Berns JS, Brier ME, Golper TA, Morrison G, Singer I, Swan SK, Bennett WM. Drug Prescribingin Renal Failure, Dosing Guidelines for Adults. 4th Ed. Philadelphia: American College of Physicians,1999:39-62.

modified 7/24/07 by Ann Marie Marr

Back to Table of Contents

Restricted access to UPHS Intranet Privacy PolicyDisclaimer