| Antimicrobial |
Dosage Adjustment |
| Aztreonam |
Reduce dose 25% when used chronically at high doses |
| Colistin |
No change necessary |
| Chloramphenicol |
Lengthen dosing interval to q12-24h. Monitor serum levels to maintain between 5-20 mg/L. |
| Clindamycin |
Lengthen dosing interval to q12h |
| Metronidazole |
Lengthen dosing interval to q12-24h |
| Trimethoprim-sulfamethoxazole |
Use with caution in hepatic impairment |
| Trimethoprim |
No change necessary |
| Fosfomycin IV/PO |
No change necessary |
| Nitrofurantoin |
No change necessary |
| Vancomycin |
Monitoring of trough levels is strongly recommended. See Vancomycin Monitoring Guidelines. |
| Linezolid |
No change necessary in patients with mild to moderate (Child Pugh A or B) impairment. No information available for patients with severe (Child Pugh C) hepatic impairment. |
| Daptomycin |
No change necessary in patients with mild to moderate (Child Pugh A or B) impairment. No information available for patients with severe (Child Pugh C) hepatic impairment. |
