Other

Antimicrobial Normal Adult Dose Dose and Interval Adjustment for Renal Impairment
Creatinine Clearance (mL/min)
>50 10 - 50 <10 (Anuric)
Aztreonam 1-2g IV q8h q8h 50-75% dose 25% dose
Colistin 5mg colistin base/kg/day IV div q8h > 70mL/min: NO CHANGE NEEDED 10-70mL/min: q8-12h < 10mL/min: q12h
Doxycycline 100mg PO/IV q12-24h NO CHANGE NEEDED
Tigecycline 100mg IV x 1 dose then 50mg IV q12h NO CHANGE NEEDED
Clindamycin 150-450mg PO q6h NO CHANGE NEEDED
  600mg IV q8h NO CHANGE NEEDED
Metronidazole 500mg PO/IV q12h NO CHANGE NEEDED
Trimethoprim-sulfamethoxazole 1 DS tab PO q12h > 25mL/min: NO CHANGE NEEDED 15-25mL/min: 50% dose < 15mL/min: DO NOT USE
  160-240mg TMP (10-15mL) IV q6, 8, or 12h > 25mL/min: NO CHANGE NEEDED 15-25mL/min: 50% dose < 15mL/min: DO NOT USE
Trimethoprim 100mg PO q12h > 30mL/min: NO CHANGE NEEDED 15-30mL/min: 50mg PO q12h < 15mL/min: DO NOT USE
Fosfomycin 3g PO once NO CHANGE NEEDED
Fosfomycin IV See adult dosing NO CHANGE NEEDED

40mL/min: 70% in 2-3 divided doses

 

30mL/min: 60% in 2-3 divided doses

 

20mL/min: 40% in 2-3 divided doses

10mL/min: 20% in 1-2 divided doses

Nitrofurantoin 50-100mg PO q6h < 40-60mL/min: CONTRAINDICATED - DO NOT USE
Nitrofurantoin (MacroBID) 100mg PO q12h < 40-60mL/min: CONTRAINDICATED - DO NOT USE
Vancomycin IV 15mg/kg IV q12h q12-24h q24-72h use serum levels to assist dosing
Vancomycin PO 125mg PO qid NO CHANGE NEEDED
Linezolid 600mg PO/IV q12h NO CHANGE NEEDED
Daptomycin 4-6mg/kg IV q24h q24h < 30mL/min: q48h