Renal adjusted antibiotics - Revision history

Danbot: Add See Also and References

2026-03-22T09:14:33Z

Add See Also and References

← Older revision		Revision as of 09:14, 22 March 2026
Line 64:		Line 64:
	\| - CrCl 25-50: Every 12 hours<br>- CrCl 10-25: Every 24 hours (half dose)<br>- CrCl <10: 2.5-5 mg/kg every 24 hours<br>PO doses also adjusted; hydrate to prevent crystalluria.		\| - CrCl 25-50: Every 12 hours<br>- CrCl 10-25: Every 24 hours (half dose)<br>- CrCl <10: 2.5-5 mg/kg every 24 hours<br>PO doses also adjusted; hydrate to prevent crystalluria.
	\|}		\|}

			==See Also==
			*[[Renal failure]]
			*[[Antibiotics]]
			*[[GFR]]

			==References==
			<references/>

	[[Category:ID]]		[[Category:ID]]
	[[Category:Pharmacology]]		[[Category:Pharmacology]]

Ostermayer at 15:47, 30 August 2025

2025-08-30T15:47:24Z

← Older revision		Revision as of 15:47, 30 August 2025
Line 60:		Line 60:
	\|-		\|-
	\| [[Acyclovir]] (antiviral)		\| [[Acyclovir]] (antiviral)
	\| [[nucleoside ~~analogue~~]]		\| [[nucleoside analog]]
	\| 5-10 mg/kg IV every 8 hours		\| 5-10 mg/kg IV every 8 hours
	\| - CrCl 25-50: Every 12 hours<br>- CrCl 10-25: Every 24 hours (half dose)<br>- CrCl <10: 2.5-5 mg/kg every 24 hours<br>PO doses also adjusted; hydrate to prevent crystalluria.		\| - CrCl 25-50: Every 12 hours<br>- CrCl 10-25: Every 24 hours (half dose)<br>- CrCl <10: 2.5-5 mg/kg every 24 hours<br>PO doses also adjusted; hydrate to prevent crystalluria.

Ostermayer: /* Antibiotics Requiring Renal Dosing */

2025-08-30T14:06:46Z

Antibiotics Requiring Renal Dosing

← Older revision		Revision as of 14:06, 30 August 2025
Line 60:		Line 60:
	\|-		\|-
	\| [[Acyclovir]] (antiviral)		\| [[Acyclovir]] (antiviral)
	\| [[nucleoside analogue]]]		\| [[nucleoside analogue]]
	\| 5-10 mg/kg IV every 8 hours		\| 5-10 mg/kg IV every 8 hours
	\| - CrCl 25-50: Every 12 hours<br>- CrCl 10-25: Every 24 hours (half dose)<br>- CrCl <10: 2.5-5 mg/kg every 24 hours<br>PO doses also adjusted; hydrate to prevent crystalluria.		\| - CrCl 25-50: Every 12 hours<br>- CrCl 10-25: Every 24 hours (half dose)<br>- CrCl <10: 2.5-5 mg/kg every 24 hours<br>PO doses also adjusted; hydrate to prevent crystalluria.

Ostermayer at 14:06, 30 August 2025

2025-08-30T14:06:33Z

← Older revision		Revision as of 14:06, 30 August 2025
Line 60:		Line 60:
	\|-		\|-
	\| [[Acyclovir]] (antiviral)		\| [[Acyclovir]] (antiviral)
	\| [[~~Nucleoside analog~~]]		\| [[nucleoside analogue]]]
	\| 5-10 mg/kg IV every 8 hours		\| 5-10 mg/kg IV every 8 hours
	\| - CrCl 25-50: Every 12 hours<br>- CrCl 10-25: Every 24 hours (half dose)<br>- CrCl <10: 2.5-5 mg/kg every 24 hours<br>PO doses also adjusted; hydrate to prevent crystalluria.		\| - CrCl 25-50: Every 12 hours<br>- CrCl 10-25: Every 24 hours (half dose)<br>- CrCl <10: 2.5-5 mg/kg every 24 hours<br>PO doses also adjusted; hydrate to prevent crystalluria.

Ostermayer: /* Antibiotics Requiring Renal Dosing */

2025-08-30T12:39:19Z

Antibiotics Requiring Renal Dosing

← Older revision		Revision as of 12:39, 30 August 2025
Line 10:		Line 10:
	\|-		\|-
	\| [[Vancomycin]]		\| [[Vancomycin]]
	\| [[~~Is DrugClass::~~Glycopeptide]]		\| [[Glycopeptide]]
	\| 15-20 mg/kg IV every 8-12 hours (target trough 10-20 mcg/mL for serious infections)		\| 15-20 mg/kg IV every 8-12 hours (target trough 10-20 mcg/mL for serious infections)
	\| - CrCl 30-60: 10-15 mg/kg every 12-24 hours<br>- CrCl 10-30: 10 mg/kg every 24-48 hours<br>- CrCl <10: 10 mg/kg every 48-72 hours or based on levels<br>Monitor trough levels closely to avoid nephrotoxicity.		\| - CrCl 30-60: 10-15 mg/kg every 12-24 hours<br>- CrCl 10-30: 10 mg/kg every 24-48 hours<br>- CrCl <10: 10 mg/kg every 48-72 hours or based on levels<br>Monitor trough levels closely to avoid nephrotoxicity.
	\|-		\|-
	\| [[Gentamicin]]		\| [[Gentamicin]]
	\| [[~~Is DrugClass::~~Aminoglycoside]]		\| [[Aminoglycoside]]
	\| 5-7 mg/kg IV once daily (extended-interval) or 1-2 mg/kg every 8 hours (traditional)		\| 5-7 mg/kg IV once daily (extended-interval) or 1-2 mg/kg every 8 hours (traditional)
	\| - CrCl 40-60: 3-5 mg/kg every 24-36 hours<br>- CrCl 20-40: 2-3 mg/kg every 36-48 hours<br>- CrCl <20: Load 2 mg/kg, then based on levels (trough <1 mcg/mL)<br>Peak/trough monitoring essential.		\| - CrCl 40-60: 3-5 mg/kg every 24-36 hours<br>- CrCl 20-40: 2-3 mg/kg every 36-48 hours<br>- CrCl <20: Load 2 mg/kg, then based on levels (trough <1 mcg/mL)<br>Peak/trough monitoring essential.
	\|-		\|-
	\| [[Tobramycin]]		\| [[Tobramycin]]
	\| [[~~Is DrugClass::~~Aminoglycoside]]		\| [[Aminoglycoside]]
	\| Similar to gentamicin: 5-7 mg/kg IV once daily		\| Similar to gentamicin: 5-7 mg/kg IV once daily
	\| - CrCl 40-60: 4-5 mg/kg every 24-36 hours<br>- CrCl 20-40: 3-4 mg/kg every 36-48 hours<br>- CrCl <20: Load 2 mg/kg, then per levels<br>Adjust for cystic fibrosis or other indications.		\| - CrCl 40-60: 4-5 mg/kg every 24-36 hours<br>- CrCl 20-40: 3-4 mg/kg every 36-48 hours<br>- CrCl <20: Load 2 mg/kg, then per levels<br>Adjust for cystic fibrosis or other indications.
	\|-		\|-
	\| [[Amikacin]]		\| [[Amikacin]]
	\| [[~~Is DrugClass::~~Aminoglycoside]]		\| [[Aminoglycoside]]
	\| 15 mg/kg IV once daily		\| 15 mg/kg IV once daily
	\| - CrCl 40-60: 10-12 mg/kg every 24-36 hours<br>- CrCl 20-40: 7.5-10 mg/kg every 36-48 hours<br>- CrCl <20: Load 7.5 mg/kg, then based on levels (trough <4-8 mcg/mL)<br>Higher risk of ototoxicity; monitor closely.		\| - CrCl 40-60: 10-12 mg/kg every 24-36 hours<br>- CrCl 20-40: 7.5-10 mg/kg every 36-48 hours<br>- CrCl <20: Load 7.5 mg/kg, then based on levels (trough <4-8 mcg/mL)<br>Higher risk of ototoxicity; monitor closely.
	\|-		\|-
	\| [[Ciprofloxacin]]		\| [[Ciprofloxacin]]
	\| [[~~Is DrugClass::~~Fluoroquinolone]]		\| [[Fluoroquinolone]]
	\| 400 mg IV every 12 hours or 500-750 mg PO every 12 hours		\| 400 mg IV every 12 hours or 500-750 mg PO every 12 hours
	\| - CrCl 30-50: No change or extend to every 18-24 hours<br>- CrCl <30: 400 mg IV every 24 hours or 250-500 mg PO every 24 hours<br>Not dialyzable; adjust for UTI vs. systemic use.		\| - CrCl 30-50: No change or extend to every 18-24 hours<br>- CrCl <30: 400 mg IV every 24 hours or 250-500 mg PO every 24 hours<br>Not dialyzable; adjust for UTI vs. systemic use.
	\|-		\|-
	\| [[Levofloxacin]]		\| [[Levofloxacin]]
	\| [[~~Is DrugClass::~~Fluoroquinolone]]		\| [[Fluoroquinolone]]
	\| 500-750 mg IV/PO once daily		\| 500-750 mg IV/PO once daily
	\| - CrCl 20-50: 500-750 mg every 48 hours (or half dose daily)<br>- CrCl <20: 250-500 mg every 48 hours (load with full dose)<br>Monitor for QT prolongation in renal impairment.		\| - CrCl 20-50: 500-750 mg every 48 hours (or half dose daily)<br>- CrCl <20: 250-500 mg every 48 hours (load with full dose)<br>Monitor for QT prolongation in renal impairment.
	\|-		\|-
	\| [[Cefepime]]		\| [[Cefepime]]
	\| [[~~Is DrugClass::~~Cephalosporin]] (4th gen)		\| [[Cephalosporin]] (4th gen)
	\| 1-2 g IV every 8-12 hours		\| 1-2 g IV every 8-12 hours
	\| - CrCl 30-60: 1-2 g every 12 hours<br>- CrCl 11-29: 1-2 g every 24 hours<br>- CrCl <11: 0.5-1 g every 24 hours<br>Increase for Pseudomonas infections.		\| - CrCl 30-60: 1-2 g every 12 hours<br>- CrCl 11-29: 1-2 g every 24 hours<br>- CrCl <11: 0.5-1 g every 24 hours<br>Increase for Pseudomonas infections.
	\|-		\|-
	\| [[Ceftazidime]]		\| [[Ceftazidime]]
	\| [[~~Is DrugClass::~~Cephalosporin]] (3rd gen)		\| [[Cephalosporin]] (3rd gen)
	\| 1-2 g IV every 8 hours		\| 1-2 g IV every 8 hours
	\| - CrCl 31-50: 1-2 g every 12 hours<br>- CrCl 16-30: 1 g every 24 hours<br>- CrCl <15: 0.5 g every 24 hours<br>Used for gram-negative coverage.		\| - CrCl 31-50: 1-2 g every 12 hours<br>- CrCl 16-30: 1 g every 24 hours<br>- CrCl <15: 0.5 g every 24 hours<br>Used for gram-negative coverage.
	\|-		\|-
	\| [[Piperacillin-Tazobactam]]		\| [[Piperacillin-Tazobactam]]
	\| [[~~Is DrugClass::~~Penicillin]]/Beta-lactamase inhibitor		\| [[Penicillin]]/Beta-lactamase inhibitor
	\| 3.375-4.5 g IV every 6 hours		\| 3.375-4.5 g IV every 6 hours
	\| - CrCl 20-40: 3.375 g every 8 hours<br>- CrCl <20: 2.25 g every 8 hours (or every 12 hours for severe impairment)<br>Extended infusion may be used for optimization.		\| - CrCl 20-40: 3.375 g every 8 hours<br>- CrCl <20: 2.25 g every 8 hours (or every 12 hours for severe impairment)<br>Extended infusion may be used for optimization.
	\|-		\|-
	\| [[Meropenem]]		\| [[Meropenem]]
	\| [[~~Is DrugClass::~~Carbapenem]]		\| [[Carbapenem]]
	\| 1 g IV every 8 hours		\| 1 g IV every 8 hours
	\| - CrCl 26-50: 1 g every 12 hours<br>- CrCl 10-25: 0.5 g every 12 hours<br>- CrCl <10: 0.5 g every 24 hours<br>Short half-life; adjust for CNS infections.		\| - CrCl 26-50: 1 g every 12 hours<br>- CrCl 10-25: 0.5 g every 12 hours<br>- CrCl <10: 0.5 g every 24 hours<br>Short half-life; adjust for CNS infections.
	\|-		\|-
	\| [[Acyclovir]] (antiviral)		\| [[Acyclovir]] (antiviral)
	\| [[~~Is DrugClass::~~Nucleoside analog]]		\| [[Nucleoside analog]]
	\| 5-10 mg/kg IV every 8 hours		\| 5-10 mg/kg IV every 8 hours
	\| - CrCl 25-50: Every 12 hours<br>- CrCl 10-25: Every 24 hours (half dose)<br>- CrCl <10: 2.5-5 mg/kg every 24 hours<br>PO doses also adjusted; hydrate to prevent crystalluria.		\| - CrCl 25-50: Every 12 hours<br>- CrCl 10-25: Every 24 hours (half dose)<br>- CrCl <10: 2.5-5 mg/kg every 24 hours<br>PO doses also adjusted; hydrate to prevent crystalluria.

Ostermayer: /* Antibiotics Requiring Renal Dosing */

2025-08-30T12:22:02Z

Antibiotics Requiring Renal Dosing

← Older revision		Revision as of 12:22, 30 August 2025
Line 10:		Line 10:
	\|-		\|-
	\| [[Vancomycin]]		\| [[Vancomycin]]
	\| Glycopeptide		\| [[Is DrugClass::Glycopeptide]]
	\| 15-20 mg/kg IV every 8-12 hours (target trough 10-20 mcg/mL for serious infections)		\| 15-20 mg/kg IV every 8-12 hours (target trough 10-20 mcg/mL for serious infections)
	\| - CrCl 30-60: 10-15 mg/kg every 12-24 hours<br>- CrCl 10-30: 10 mg/kg every 24-48 hours<br>- CrCl <10: 10 mg/kg every 48-72 hours or based on levels<br>Monitor trough levels closely to avoid nephrotoxicity.		\| - CrCl 30-60: 10-15 mg/kg every 12-24 hours<br>- CrCl 10-30: 10 mg/kg every 24-48 hours<br>- CrCl <10: 10 mg/kg every 48-72 hours or based on levels<br>Monitor trough levels closely to avoid nephrotoxicity.
	\|-		\|-
	\| [[Gentamicin]]		\| [[Gentamicin]]
	\| Aminoglycoside		\| [[Is DrugClass::Aminoglycoside]]
	\| 5-7 mg/kg IV once daily (extended-interval) or 1-2 mg/kg every 8 hours (traditional)		\| 5-7 mg/kg IV once daily (extended-interval) or 1-2 mg/kg every 8 hours (traditional)
	\| - CrCl 40-60: 3-5 mg/kg every 24-36 hours<br>- CrCl 20-40: 2-3 mg/kg every 36-48 hours<br>- CrCl <20: Load 2 mg/kg, then based on levels (trough <1 mcg/mL)<br>Peak/trough monitoring essential.		\| - CrCl 40-60: 3-5 mg/kg every 24-36 hours<br>- CrCl 20-40: 2-3 mg/kg every 36-48 hours<br>- CrCl <20: Load 2 mg/kg, then based on levels (trough <1 mcg/mL)<br>Peak/trough monitoring essential.
	\|-		\|-
	\| [[Tobramycin]]		\| [[Tobramycin]]
	\| Aminoglycoside		\| [[Is DrugClass::Aminoglycoside]]
	\| Similar to gentamicin: 5-7 mg/kg IV once daily		\| Similar to gentamicin: 5-7 mg/kg IV once daily
	\| - CrCl 40-60: 4-5 mg/kg every 24-36 hours<br>- CrCl 20-40: 3-4 mg/kg every 36-48 hours<br>- CrCl <20: Load 2 mg/kg, then per levels<br>Adjust for cystic fibrosis or other indications.		\| - CrCl 40-60: 4-5 mg/kg every 24-36 hours<br>- CrCl 20-40: 3-4 mg/kg every 36-48 hours<br>- CrCl <20: Load 2 mg/kg, then per levels<br>Adjust for cystic fibrosis or other indications.
	\|-		\|-
	\| [[Amikacin]]		\| [[Amikacin]]
	\| Aminoglycoside		\| [[Is DrugClass::Aminoglycoside]]
	\| 15 mg/kg IV once daily		\| 15 mg/kg IV once daily
	\| - CrCl 40-60: 10-12 mg/kg every 24-36 hours<br>- CrCl 20-40: 7.5-10 mg/kg every 36-48 hours<br>- CrCl <20: Load 7.5 mg/kg, then based on levels (trough <4-8 mcg/mL)<br>Higher risk of ototoxicity; monitor closely.		\| - CrCl 40-60: 10-12 mg/kg every 24-36 hours<br>- CrCl 20-40: 7.5-10 mg/kg every 36-48 hours<br>- CrCl <20: Load 7.5 mg/kg, then based on levels (trough <4-8 mcg/mL)<br>Higher risk of ototoxicity; monitor closely.
	\|-		\|-
	\| [[Ciprofloxacin]]		\| [[Ciprofloxacin]]
	\| Fluoroquinolone		\| [[Is DrugClass::Fluoroquinolone]]
	\| 400 mg IV every 12 hours or 500-750 mg PO every 12 hours		\| 400 mg IV every 12 hours or 500-750 mg PO every 12 hours
	\| - CrCl 30-50: No change or extend to every 18-24 hours<br>- CrCl <30: 400 mg IV every 24 hours or 250-500 mg PO every 24 hours<br>Not dialyzable; adjust for UTI vs. systemic use.		\| - CrCl 30-50: No change or extend to every 18-24 hours<br>- CrCl <30: 400 mg IV every 24 hours or 250-500 mg PO every 24 hours<br>Not dialyzable; adjust for UTI vs. systemic use.
	\|-		\|-
	\| [[Levofloxacin]]		\| [[Levofloxacin]]
	\| Fluoroquinolone		\| [[Is DrugClass::Fluoroquinolone]]
	\| 500-750 mg IV/PO once daily		\| 500-750 mg IV/PO once daily
	\| - CrCl 20-50: 500-750 mg every 48 hours (or half dose daily)<br>- CrCl <20: 250-500 mg every 48 hours (load with full dose)<br>Monitor for QT prolongation in renal impairment.		\| - CrCl 20-50: 500-750 mg every 48 hours (or half dose daily)<br>- CrCl <20: 250-500 mg every 48 hours (load with full dose)<br>Monitor for QT prolongation in renal impairment.
	\|-		\|-
	\| [[Cefepime]]		\| [[Cefepime]]
	\| Cephalosporin (4th gen)		\| [[Is DrugClass::Cephalosporin]] (4th gen)
	\| 1-2 g IV every 8-12 hours		\| 1-2 g IV every 8-12 hours
	\| - CrCl 30-60: 1-2 g every 12 hours<br>- CrCl 11-29: 1-2 g every 24 hours<br>- CrCl <11: 0.5-1 g every 24 hours<br>Increase for Pseudomonas infections.		\| - CrCl 30-60: 1-2 g every 12 hours<br>- CrCl 11-29: 1-2 g every 24 hours<br>- CrCl <11: 0.5-1 g every 24 hours<br>Increase for Pseudomonas infections.
	\|-		\|-
	\| [[Ceftazidime]]		\| [[Ceftazidime]]
	\| Cephalosporin (3rd gen)		\| [[Is DrugClass::Cephalosporin]] (3rd gen)
	\| 1-2 g IV every 8 hours		\| 1-2 g IV every 8 hours
	\| - CrCl 31-50: 1-2 g every 12 hours<br>- CrCl 16-30: 1 g every 24 hours<br>- CrCl <15: 0.5 g every 24 hours<br>Used for gram-negative coverage.		\| - CrCl 31-50: 1-2 g every 12 hours<br>- CrCl 16-30: 1 g every 24 hours<br>- CrCl <15: 0.5 g every 24 hours<br>Used for gram-negative coverage.
	\|-		\|-
	\| [[Piperacillin-Tazobactam]]		\| [[Piperacillin-Tazobactam]]
	\| Penicillin/Beta-lactamase inhibitor		\| [[Is DrugClass::Penicillin]]/Beta-lactamase inhibitor
	\| 3.375-4.5 g IV every 6 hours		\| 3.375-4.5 g IV every 6 hours
	\| - CrCl 20-40: 3.375 g every 8 hours<br>- CrCl <20: 2.25 g every 8 hours (or every 12 hours for severe impairment)<br>Extended infusion may be used for optimization.		\| - CrCl 20-40: 3.375 g every 8 hours<br>- CrCl <20: 2.25 g every 8 hours (or every 12 hours for severe impairment)<br>Extended infusion may be used for optimization.
	\|-		\|-
	\| [[Meropenem]]		\| [[Meropenem]]
	\| Carbapenem		\| [[Is DrugClass::Carbapenem]]
	\| 1 g IV every 8 hours		\| 1 g IV every 8 hours
	\| - CrCl 26-50: 1 g every 12 hours<br>- CrCl 10-25: 0.5 g every 12 hours<br>- CrCl <10: 0.5 g every 24 hours<br>Short half-life; adjust for CNS infections.		\| - CrCl 26-50: 1 g every 12 hours<br>- CrCl 10-25: 0.5 g every 12 hours<br>- CrCl <10: 0.5 g every 24 hours<br>Short half-life; adjust for CNS infections.
	\|-		\|-
	\| [[Acyclovir]] (antiviral)		\| [[Acyclovir]] (antiviral)
	\| Nucleoside analog		\| [[Is DrugClass::Nucleoside analog]]
	\| 5-10 mg/kg IV every 8 hours		\| 5-10 mg/kg IV every 8 hours
	\| - CrCl 25-50: Every 12 hours<br>- CrCl 10-25: Every 24 hours (half dose)<br>- CrCl <10: 2.5-5 mg/kg every 24 hours<br>PO doses also adjusted; hydrate to prevent crystalluria.		\| - CrCl 25-50: Every 12 hours<br>- CrCl 10-25: Every 24 hours (half dose)<br>- CrCl <10: 2.5-5 mg/kg every 24 hours<br>PO doses also adjusted; hydrate to prevent crystalluria.

Ostermayer at 12:18, 30 August 2025

2025-08-30T12:18:08Z

← Older revision		Revision as of 12:18, 30 August 2025
Line 9:		Line 9:
	! Renal Adjustment Examples		! Renal Adjustment Examples
	\|-		\|-
	\| Vancomycin		\| [[Vancomycin]]
	\| Glycopeptide		\| Glycopeptide
	\| 15-20 mg/kg IV every 8-12 hours (target trough 10-20 mcg/mL for serious infections)		\| 15-20 mg/kg IV every 8-12 hours (target trough 10-20 mcg/mL for serious infections)
	\| - CrCl 30-60: 10-15 mg/kg every 12-24 hours<br>- CrCl 10-30: 10 mg/kg every 24-48 hours<br>- CrCl <10: 10 mg/kg every 48-72 hours or based on levels<br>Monitor trough levels closely to avoid nephrotoxicity.		\| - CrCl 30-60: 10-15 mg/kg every 12-24 hours<br>- CrCl 10-30: 10 mg/kg every 24-48 hours<br>- CrCl <10: 10 mg/kg every 48-72 hours or based on levels<br>Monitor trough levels closely to avoid nephrotoxicity.
	\|-		\|-
	\| Gentamicin		\| [[Gentamicin]]
	\| Aminoglycoside		\| Aminoglycoside
	\| 5-7 mg/kg IV once daily (extended-interval) or 1-2 mg/kg every 8 hours (traditional)		\| 5-7 mg/kg IV once daily (extended-interval) or 1-2 mg/kg every 8 hours (traditional)
	\| - CrCl 40-60: 3-5 mg/kg every 24-36 hours<br>- CrCl 20-40: 2-3 mg/kg every 36-48 hours<br>- CrCl <20: Load 2 mg/kg, then based on levels (trough <1 mcg/mL)<br>Peak/trough monitoring essential.		\| - CrCl 40-60: 3-5 mg/kg every 24-36 hours<br>- CrCl 20-40: 2-3 mg/kg every 36-48 hours<br>- CrCl <20: Load 2 mg/kg, then based on levels (trough <1 mcg/mL)<br>Peak/trough monitoring essential.
	\|-		\|-
	\| Tobramycin		\| [[Tobramycin]]
	\| Aminoglycoside		\| Aminoglycoside
	\| Similar to gentamicin: 5-7 mg/kg IV once daily		\| Similar to gentamicin: 5-7 mg/kg IV once daily
	\| - CrCl 40-60: 4-5 mg/kg every 24-36 hours<br>- CrCl 20-40: 3-4 mg/kg every 36-48 hours<br>- CrCl <20: Load 2 mg/kg, then per levels<br>Adjust for cystic fibrosis or other indications.		\| - CrCl 40-60: 4-5 mg/kg every 24-36 hours<br>- CrCl 20-40: 3-4 mg/kg every 36-48 hours<br>- CrCl <20: Load 2 mg/kg, then per levels<br>Adjust for cystic fibrosis or other indications.
	\|-		\|-
	\| Amikacin		\| [[Amikacin]]
	\| Aminoglycoside		\| Aminoglycoside
	\| 15 mg/kg IV once daily		\| 15 mg/kg IV once daily
	\| - CrCl 40-60: 10-12 mg/kg every 24-36 hours<br>- CrCl 20-40: 7.5-10 mg/kg every 36-48 hours<br>- CrCl <20: Load 7.5 mg/kg, then based on levels (trough <4-8 mcg/mL)<br>Higher risk of ototoxicity; monitor closely.		\| - CrCl 40-60: 10-12 mg/kg every 24-36 hours<br>- CrCl 20-40: 7.5-10 mg/kg every 36-48 hours<br>- CrCl <20: Load 7.5 mg/kg, then based on levels (trough <4-8 mcg/mL)<br>Higher risk of ototoxicity; monitor closely.
	\|-		\|-
	\| Ciprofloxacin		\| [[Ciprofloxacin]]
	\| Fluoroquinolone		\| Fluoroquinolone
	\| 400 mg IV every 12 hours or 500-750 mg PO every 12 hours		\| 400 mg IV every 12 hours or 500-750 mg PO every 12 hours
	\| - CrCl 30-50: No change or extend to every 18-24 hours<br>- CrCl <30: 400 mg IV every 24 hours or 250-500 mg PO every 24 hours<br>Not dialyzable; adjust for UTI vs. systemic use.		\| - CrCl 30-50: No change or extend to every 18-24 hours<br>- CrCl <30: 400 mg IV every 24 hours or 250-500 mg PO every 24 hours<br>Not dialyzable; adjust for UTI vs. systemic use.
	\|-		\|-
	\| Levofloxacin		\| [[Levofloxacin]]
	\| Fluoroquinolone		\| Fluoroquinolone
	\| 500-750 mg IV/PO once daily		\| 500-750 mg IV/PO once daily
	\| - CrCl 20-50: 500-750 mg every 48 hours (or half dose daily)<br>- CrCl <20: 250-500 mg every 48 hours (load with full dose)<br>Monitor for QT prolongation in renal impairment.		\| - CrCl 20-50: 500-750 mg every 48 hours (or half dose daily)<br>- CrCl <20: 250-500 mg every 48 hours (load with full dose)<br>Monitor for QT prolongation in renal impairment.
	\|-		\|-
	\| Cefepime		\| [[Cefepime]]
	\| Cephalosporin (4th gen)		\| Cephalosporin (4th gen)
	\| 1-2 g IV every 8-12 hours		\| 1-2 g IV every 8-12 hours
	\| - CrCl 30-60: 1-2 g every 12 hours<br>- CrCl 11-29: 1-2 g every 24 hours<br>- CrCl <11: 0.5-1 g every 24 hours<br>Increase for Pseudomonas infections.		\| - CrCl 30-60: 1-2 g every 12 hours<br>- CrCl 11-29: 1-2 g every 24 hours<br>- CrCl <11: 0.5-1 g every 24 hours<br>Increase for Pseudomonas infections.
	\|-		\|-
	\| Ceftazidime		\| [[Ceftazidime]]
	\| Cephalosporin (3rd gen)		\| Cephalosporin (3rd gen)
	\| 1-2 g IV every 8 hours		\| 1-2 g IV every 8 hours
	\| - CrCl 31-50: 1-2 g every 12 hours<br>- CrCl 16-30: 1 g every 24 hours<br>- CrCl <15: 0.5 g every 24 hours<br>Used for gram-negative coverage.		\| - CrCl 31-50: 1-2 g every 12 hours<br>- CrCl 16-30: 1 g every 24 hours<br>- CrCl <15: 0.5 g every 24 hours<br>Used for gram-negative coverage.
	\|-		\|-
	\| Piperacillin-Tazobactam		\| [[Piperacillin-Tazobactam]]
	\| Penicillin/Beta-lactamase inhibitor		\| Penicillin/Beta-lactamase inhibitor
	\| 3.375-4.5 g IV every 6 hours		\| 3.375-4.5 g IV every 6 hours
	\| - CrCl 20-40: 3.375 g every 8 hours<br>- CrCl <20: 2.25 g every 8 hours (or every 12 hours for severe impairment)<br>Extended infusion may be used for optimization.		\| - CrCl 20-40: 3.375 g every 8 hours<br>- CrCl <20: 2.25 g every 8 hours (or every 12 hours for severe impairment)<br>Extended infusion may be used for optimization.
	\|-		\|-
	\| Meropenem		\| [[Meropenem]]
	\| Carbapenem		\| Carbapenem
	\| 1 g IV every 8 hours		\| 1 g IV every 8 hours
	\| - CrCl 26-50: 1 g every 12 hours<br>- CrCl 10-25: 0.5 g every 12 hours<br>- CrCl <10: 0.5 g every 24 hours<br>Short half-life; adjust for CNS infections.		\| - CrCl 26-50: 1 g every 12 hours<br>- CrCl 10-25: 0.5 g every 12 hours<br>- CrCl <10: 0.5 g every 24 hours<br>Short half-life; adjust for CNS infections.
	\|-		\|-
	\| Acyclovir (antiviral~~, often included~~)		\| [[Acyclovir]] (antiviral)
	\| Nucleoside analog		\| Nucleoside analog
	\| 5-10 mg/kg IV every 8 hours		\| 5-10 mg/kg IV every 8 hours

Ostermayer at 12:15, 30 August 2025

2025-08-30T12:15:23Z

← Older revision		Revision as of 12:15, 30 August 2025
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	== ~~Detailed List of~~ Antibiotics Requiring Renal Dosing ==		==Antibiotics Requiring Renal Dosing ==

	I've organized this in a table for clarity. The "Normal Dose" assumes CrCl >60 mL/min. Adjustments are examples for common indications like systemic infections; always monitor levels (e.g., troughs for vancomycin/aminoglycosides) and adjust accordingly.

	{\| class="wikitable sortable"		{\| class="wikitable sortable"

Ostermayer: Created page with " == Detailed List of Antibiotics Requiring Renal Dosing == I've organized this in a table for clarity. The "Normal Dose" assumes CrCl >60 mL/min. Adjustments are examples for common indications like systemic infections; always monitor levels (e.g., troughs for vancomycin/aminoglycosides) and adjust accordingly. {| class="wikitable sortable" |- ! Antibiotic ! Class ! Normal Dose (CrCl >60 mL/min) ! Renal Adjustment Examples |- | Vancomycin | Glycopeptide | 15-20 mg/kg I..."

2025-08-30T12:14:56Z

Created page with " == Detailed List of Antibiotics Requiring Renal Dosing == I've organized this in a table for clarity. The "Normal Dose" assumes CrCl >60 mL/min. Adjustments are examples for common indications like systemic infections; always monitor levels (e.g., troughs for vancomycin/aminoglycosides) and adjust accordingly. {| class="wikitable sortable" |- ! Antibiotic ! Class ! Normal Dose (CrCl >60 mL/min) ! Renal Adjustment Examples |- | Vancomycin | Glycopeptide | 15-20 mg/kg I..."

New page

== Detailed List of Antibiotics Requiring Renal Dosing ==

I've organized this in a table for clarity. The "Normal Dose" assumes CrCl >60 mL/min. Adjustments are examples for common indications like systemic infections; always monitor levels (e.g., troughs for vancomycin/aminoglycosides) and adjust accordingly.

{| class="wikitable sortable"
|-
! Antibiotic
! Class
! Normal Dose (CrCl >60 mL/min)
! Renal Adjustment Examples
|-
| Vancomycin
| Glycopeptide
| 15-20 mg/kg IV every 8-12 hours (target trough 10-20 mcg/mL for serious infections)
| - CrCl 30-60: 10-15 mg/kg every 12-24 hours - CrCl 10-30: 10 mg/kg every 24-48 hours - CrCl <10: 10 mg/kg every 48-72 hours or based on levels Monitor trough levels closely to avoid nephrotoxicity.
|-
| Gentamicin
| Aminoglycoside
| 5-7 mg/kg IV once daily (extended-interval) or 1-2 mg/kg every 8 hours (traditional)
| - CrCl 40-60: 3-5 mg/kg every 24-36 hours - CrCl 20-40: 2-3 mg/kg every 36-48 hours - CrCl <20: Load 2 mg/kg, then based on levels (trough <1 mcg/mL) Peak/trough monitoring essential.
|-
| Tobramycin
| Aminoglycoside
| Similar to gentamicin: 5-7 mg/kg IV once daily
| - CrCl 40-60: 4-5 mg/kg every 24-36 hours - CrCl 20-40: 3-4 mg/kg every 36-48 hours - CrCl <20: Load 2 mg/kg, then per levels Adjust for cystic fibrosis or other indications.
|-
| Amikacin
| Aminoglycoside
| 15 mg/kg IV once daily
| - CrCl 40-60: 10-12 mg/kg every 24-36 hours - CrCl 20-40: 7.5-10 mg/kg every 36-48 hours - CrCl <20: Load 7.5 mg/kg, then based on levels (trough <4-8 mcg/mL) Higher risk of ototoxicity; monitor closely.
|-
| Ciprofloxacin
| Fluoroquinolone
| 400 mg IV every 12 hours or 500-750 mg PO every 12 hours
| - CrCl 30-50: No change or extend to every 18-24 hours - CrCl <30: 400 mg IV every 24 hours or 250-500 mg PO every 24 hours Not dialyzable; adjust for UTI vs. systemic use.
|-
| Levofloxacin
| Fluoroquinolone
| 500-750 mg IV/PO once daily
| - CrCl 20-50: 500-750 mg every 48 hours (or half dose daily) - CrCl <20: 250-500 mg every 48 hours (load with full dose) Monitor for QT prolongation in renal impairment.
|-
| Cefepime
| Cephalosporin (4th gen)
| 1-2 g IV every 8-12 hours
| - CrCl 30-60: 1-2 g every 12 hours - CrCl 11-29: 1-2 g every 24 hours - CrCl <11: 0.5-1 g every 24 hours Increase for Pseudomonas infections.
|-
| Ceftazidime
| Cephalosporin (3rd gen)
| 1-2 g IV every 8 hours
| - CrCl 31-50: 1-2 g every 12 hours - CrCl 16-30: 1 g every 24 hours - CrCl <15: 0.5 g every 24 hours Used for gram-negative coverage.
|-
| Piperacillin-Tazobactam
| Penicillin/Beta-lactamase inhibitor
| 3.375-4.5 g IV every 6 hours
| - CrCl 20-40: 3.375 g every 8 hours - CrCl <20: 2.25 g every 8 hours (or every 12 hours for severe impairment) Extended infusion may be used for optimization.
|-
| Meropenem
| Carbapenem
| 1 g IV every 8 hours
| - CrCl 26-50: 1 g every 12 hours - CrCl 10-25: 0.5 g every 12 hours - CrCl <10: 0.5 g every 24 hours Short half-life; adjust for CNS infections.
|-
| Acyclovir (antiviral, often included)
| Nucleoside analog
| 5-10 mg/kg IV every 8 hours
| - CrCl 25-50: Every 12 hours - CrCl 10-25: Every 24 hours (half dose) - CrCl <10: 2.5-5 mg/kg every 24 hours PO doses also adjusted; hydrate to prevent crystalluria.
|}

[[Category:ID]]
[[Category:Pharmacology]]