Penicillins

Antimicrobial Normal Adult Dose Dose and Interval Adjustment for Renal Impairment
Creatinine Clearance (mL/min)
>50 10 - 50 <10 (Anuric)
Amoxicillin 500mg PO q8h q8h q8-12h q12-24h
Amoxicillin-clavulanate 500mg PO q8h q8h 10-30mL /min: q12h q24h
  875mg PO q12h > 30mL/min: NO CHANGE NEEDED ≤ 30mL/min: Do not use 875mg tab; use 500mg tab (see recommendations above)
  1000mg-200mg IV q8h

> 30mL/min:

NO CHANGE

NEEDED

10-30mL /min: 

Initial dose of 1000mg-200mg, then 500mg-100mg q12h

Initial dose of 1000mg-200mg, then 500mg-100mg q24h
Ampicillin 1-2g IV q4-6h q4-6h q6-12h q12-24h
Penicillin VK 300mg PO q6h q6h q8h q12h
Penicillin G Na 3-4MU IV q4-6h q6h q8h q12h
Cloxacillin 500mg PO q6h NO CHANGE NEEDED
  1-2g IV q4-6h NO CHANGE NEEDED
Piperacillin-tazobactam 3.375g IV q6h 3.375g q6h 2.25g q6h 2.25g q8h
  4.5g IV q8h ≥ 20mL/min: NO CHANGE NEEDED < 20mL/min: 4.5g q12h
  4.5g IV q6h q6h 3.375g q6h 2.25g q6h