Antifungal

Antimicrobial Normal Adult Dose Dose and Interval Adjustment for Renal Impairment
Creatinine Clearance (mL/min)
>50 10 - 50 <10 (Anuric)
Amphotericin B 0.5-1 mg/kg IV daily q24h q24h q24-36h
Anidulafungin 200mg IV once then 100mg IV daily NO CHANGE NEEDED
Caspofungin 70mg IV once then 50mg IV daily NO CHANGE NEEDED
Fluconazole 400mg PO/IV daily q24h q24-48h q48-72h
Flucytosine 37.5mg/kg PO q6h q12h q12-24h q24h
Isavuconazole 200mg PO/IV daily NO CHANGE NEEDED
Itraconazole 100-200 mg PO daily NO CHANGE NEEDED
Ketoconazole 200-400 mg PO daily NO CHANGE NEEDED
Micafungin 100mg IV daily NO CHANGE NEEDED
Posaconazole 400mg PO bid NO CHANGE NEEDED
Voriconazole 4mg/kg IV q12h NO CHANGE NEEDED Accumulation & resultant toxicity of the diluent can occur if Clcr < 50mL/min. Use oral voriconazole at normal doses.
  200mg PO q12h NO CHANGE NEEDED