Note: The dosing recommendations are not intended for treatment of endocarditis or central nervous system infections.
| Drug | Recommended Dose for IHD | Dose After IHD?* | Loading Dose?† | Recommended Dose for CRRT |
|---|---|---|---|---|
| acyclovir (IV) | 2.5-5 mg/kg IV q24h | Yes | None Required | 5-10 mg/kg IV q12-24h |
| aminoglycosides | Refer to aminoglycoside dosing guidelines | Yes | Yes | Refer to aminoglycoside dosing guidelines |
| amoxicillin | 500 mg PO q24h | Yes | None Required | 500 mg PO q8-12h |
| amoxicillin/clavulanic acid | 500/125 mg PO q24h | Yes | None Required | Limited data |
| ampicillin | 1-2 g IV q12-24h (dose dependent on indication) |
Yes | 2 g | 1-2 g IV q6-8h (dose dependent on indication) |
| azithromycin | 250-500 mg IV/PO q24h (No adjustment needed) |
No | None Required | 250-500 mg IV/PO q24h (No adjustment needed) |
| caspofungin | 70 mg IV x 1 dose, then 50 mg IV q24h (no adjustment needed) |
No | 70 mg (if load not given previously) |
70 mg IV x 1 dose, then 50 mg IV q24h (no adjustment needed) |
| ceFAZolin | 1 g IV q24h or 2 g IV post hemodialysis‡ |
Yes | 2 g | 2 g IV q12h |
| cefTAZidime | 1 g IV q24h or 1-2 g IV post-hemodialysis |
Yes | 2 g | 2 g IV q8-12h |
| cefTRIAXone | 1-2 g IV q24h (No adjustment needed) |
No | 2 g | 1-2 g IV q12-24h (No adjustment needed) |
| cefuroxime | 500 mg PO q12h | Yes | None Required | Limited data |
| ciprofloxacin | 400 mg IV q24h 500 mg PO q24h |
Yes | None Required | 400 mg IV q8-12h 500-750mg PO q12h (dose dependent on indication) |
| clindamycin (IV) | 600-900 mg IV q8h (No adjustment needed) |
No | None Required | 600-900 mg IV q8h (No adjustment needed) |
| co-trimoxazole (PO) | Dose dependent on indication: consult Infectious Disease/pharmacy | |||
| DAPTOmycin | 4-10 mg/kg IV q48h | Yes | None Required | 4-10 mg/kg IV q24h |
| ertapenem | 500 mg IV q24h | Yes | None Required | 1000 mg IV q24h |
| fluconazole | 400-800 mg IV/PO loading dose, then 100-400 mg IV/PO q24h (dose dependent on indication) |
Yes | 400-800 mg (if load not given previously) |
Loading dose: 800 mg IV/PO Maintenance dose: 600-800 mg/day IV/PO in 1 to 2 divided doses (dose dependent on indication) |
| levofloxacin§ | 750 mg IV/PO initial dose, then 500 mg q48h | Yes | 750 mg | 500-750 mg IV/PO q24h |
| Linezolid | 600 mg IV/PO q12h (No adjustment needed) |
Yes | None Required | 600 mg IV/PO q12h (No adjustment needed) |
| meropenem | 500-1000 mg IV q24h (dose dependent on indication) |
Yes | 1 g | 1-2 g IV q8h (dose dependent on indication) |
| metroNIDAZOLE | 500 mg IV/PO q12h C. difficile: 500 mg IV/PO q8h (No adjustment needed) |
Yes | None Required | 500 mg IV/PO q12h C. difficile: 500 mg IV/PO q8h (No adjustment needed) |
| moxifloxacin§ | 400 mg IV/PO q24h (No adjustment needed) |
No | None Required | 400 mg IV/PO q24h (No adjustment needed) |
oseltamivir (treatment dose) |
Limited data 30 mg PO post-IHD over the course of 5 days |
Yes | None Required | Limited data 75 mg PO q24h |
oseltamivir (prophylaxis dose) |
Limited data 30 mg post every other-IHD until outbreak is over |
Yes | None Required | Limited data |
| penicillin G | 1-2 Million Units (MU) IV q4-6h (dose dependent on indication) |
Yes | None Required | 2-4 Million Units (MU) IV q4-6h (dose dependent on indication) |
| piperacillin/tazobactam | 2.25 g IV q8h | Yes | None Required | 3.375-4.5 g IV q6h |
| tigecycline | 100 mg IV x 1 dose, then 50 mg IV q12h (No adjustment needed) |
No | 100 mg (if load not given previously) |
100 mg IV x 1 dose, then 50 mg IV q12h (No adjustment needed) |
| vancomycin | Refer to vancomycin HD dosage guidelines | Yes | Yes | Refer to vancomycin HD dosage guidelines |
* Dosing after IHD means space dosing so that one dose is given after hemodialysis (NOT a supplemental dose). For example, for a drug dosed q12h: on hemodialysis days, if patient is dialyzed in the morning, give dose at noon after dialysis and next dose at midnight.
† Loading dose not generally required if antimicrobial initiated prior to starting CVVHDF.
‡ Only given on hemodialysis days.
§ Moxifloxacin is the respiratory fluoroquinolone on formulary at Niagara Health.
Heintz BH et al. Antimicrobial Dosing Concepts and Recommendations for Critically Ill Adult Patients Receiving Continuous Renal Replacement Therapy or Intermittent Hemodialysis. Pharmacotherapy 2009;29(5):562-577.
Aronoff GR et al. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults, Fourth Edition. Philadelphia, PA: American College of Physicians. 2002.
Trotman RL et al. Antibiotic dosing in critically ill patients receiving continuous renal replacement therapy. Clin Infect Dis. 2005; 41:1159–66
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