MEDICINE III

RENAL MODIFICATION OF ANTIBIOTICS DOSE

1. AMIKACIN
CLEARANCE (ml/min) DOSE FREQUENCY
>60 15 mg/kg Q24h
40-59 15 mg/kg Q36h
30-49 15 mg/kg Q48h
20-30 5 - 7.5 mg/kg Q24h
10-20 5 - 7.5 mg/kg Q48h
<10 5 – 7.5 mg/kg Q72h
Hemodialysis 5 – 7.5 mg/kg Post HD

2. PIPERACILLIN-TAZOBACTUM (PIPTAZ)

CLEARANCE (ml/min) DOSE FREQUENCY

>40 No adjustment
20-49 2.25 g Q6h
<20 2.25 g Q8h
Hemodialysis 2.25 g Q12h

3. VANCOMYCIN

CLEARANCE (ml/min) DOSE FREQUENCY

>50 15 – 20 mg/kg Q12h
30-49 15 – 20 mg/kg Q24h
15-29 10 – 15 mg/kg Q24h
<15 10 – 15 mg/kg Q48h
Hemodialysis 10 – 15 mg/kg Post HD

4. MEROPENEM

CLEARANCE (ml/min) DOSE FREQUENCY

>50 1-2g Q8h
26-50 1-2g Q12h
10-25 0.5 - 1 g Q12h
<10 0.5 g Q12h
Hemodialysis 0.5 g Q24h / Post HD