UNIVERSITY OF PENNSYLVANIA MEDICAL CENTER

GUIDELINES FOR ANTIBIOTIC USE

PROPHYLAXIS MEDICATION GUIDELINES FOR KIDNEY TRANSPLANT

Indication Patient Population Medication Dose Duration of Therapy
Antiviral
CMV D+/R- valganciclovir

900 mg PO qd1,2

180 days
CMV D+/R+ OR CMV D-/R+ valganciclovir 450 mg PO qd1,2 90 days
CMV D-/R- acyclovir 400 mg PO BID1 90 days
Antifungal
All patients nystatin 5cc Swish/Swallow tid Until Bottle is Finished3
PCP
All patients cotrimoxazole1,4 1 SS tablet PO qd 180 days
GI
All patients ranitidine5 150 mg PO bid Indefinitely
Lipids
All patients pravastatin6 20 mg PO qd at bedtime Indefinitely

1 Adjust for renal insufficiency

2 If on long term dialysis, do not use valganciclovir. Use ganciclovir 500 mg PO three times a week given after dialysis and check with nephrologist for duration of therapy.

3 Applies to patients on and off of prednisone therapy.

4 Cotrimoxazole is sulfamethoxazole + trimethoprim; some trade names are Septra and Bactrim. A single strength (SS) tablet contains 80 mg trimethoprim and 400 mg sulfamethoxazole. If sulfa allergy: start atovaquone suspension 1500 mg PO qd. If unable to take atovaquone then check G6PD deficiency and if NOT deficient start dapsone 100 mg PO qd. If G6PD deficient check with nephrologist for alternative therapy.

5 If already on a proton pump inhibitor (PPI) then continue that agent. Ranitidine needs dosage adjustment for renal insufficiency: >50 ml/min, 150 po bid; <50, 150 mg po once daily; hemodialysis, 150 mg po once daily, with administration of dose after dialysis on dialysis day.

6 If already on a statin then continue same statin and dose. Dosing in liver failure is uncertain - use caution and consult with Pharmacy.

 

Anti-infective Prophylaxis During Treatment of Rejection Episodes
Treatment with Thymoglobulin, OKT3, or ATGAM Restart PCP and antiviral prophylaxis per above guidelines. Do not restart antifungal prophylaxis
Pulse Dose Steroids Alone Do not restart any anti-infective prophylaxis

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written by Emily Blumberg and Lori LaRosa October 2005