Antimicrobial dosages for adults with impaired kidney function: F

This table gives dosing recommendations for adults with impaired kidney function. For antimicrobial dosing in children with impaired kidney function, seek expert advice.

Table 1. Antimicrobial dosages for adults with impaired kidney function: F
[NB1]
famciclovir fidaxomicin flucloxacillin intravenous flucloxacillin oral fluconazole flucytosine	foscarnet fosfomycin (single-dose oral therapy) fusidate sodium
famciclovir
Dosage adjustment based on GFR [NB2]
more than 50 mL/min	normal
10 to 50 mL/min	dosage depends on the indication and patient’s immune status; see product information
less than 10 mL/min
Dosages for dialysis
intermittent haemodialysis	dosage depends on the indication and patient’s immune status; see product information
peritoneal dialysis
continuous renal replacement therapy
fidaxomicin
Dosage adjustment based on GFR
more than 50 mL/min	normal
10 to 50 mL/min	normal
less than 10 mL/min	normal
Dosages for dialysis
intermittent haemodialysis	normal
peritoneal dialysis	normal
continuous renal replacement therapy	normal
flucloxacillin intravenous
Dosage adjustment based on GFR [NB2] [NB3]
more than 50 mL/min	normal
10 to 50 mL/min	normal
less than 10 mL/min	50% 6- to 8-hourly
Dosages for dialysis [NB3]
intermittent haemodialysis	as for GFR less than 10 mL/min
peritoneal dialysis	as for GFR less than 10 mL/min
continuous renal replacement therapy	100% 6- to 8-hourly
flucloxacillin oral
Dosage adjustment based on GFR [NB2] [NB3]
more than 50 mL/min	normal
10 to 50 mL/min	normal
less than 10 mL/min	100% 8-hourly
Dosages for dialysis [NB2]
intermittent haemodialysis	as for GFR less than 10 mL/min
peritoneal dialysis	as for GFR less than 10 mL/min
continuous renal replacement therapy	normal
fluconazole
give normal dosage for the first 48 hours as a loading dosePatel, 2011 Sinnollareddy, 2011
Dosage adjustment based on GFR [NB2] [NB3]
more than 50 mL/min	normal
30 to 50 mL/min	50 to 100% 24-hourly
less than 30 mL/min	25 to 50% 24-hourly
Dosages for dialysis [NB3]
intermittent haemodialysis	as for GFR less than 10 mL/min; dose after dialysis
peritoneal dialysis	as for GFR less than 10 mL/min
continuous renal replacement therapy	200% 24-hourly Muilwijk, 2020 Patel, 2011
flucytosine
if possible, monitor blood concentration in patients with kidney impairment; see Monitoring antimicrobial blood concentrations
Dosage adjustment based on GFR [NB2] [NB3]
more than 40 mL/min	normal
20 to 40 mL/min	100% 12-hourly
10 to 19 mL/min	100% 24-hourly
less than 10 mL/min	100% 24- to 48-hourly
Dosages for dialysis [NB3]
intermittent haemodialysis	as for GFR less than 10 mL/min; dose after dialysis
peritoneal dialysis	as for GFR less than 10 mL/min
continuous renal replacement therapy	100% 12- to 24-hourly
foscarnet
Dosage adjustment based on GFR
more than 50 mL/min	seek expert advice
10 to 50 mL/min
less than 10 mL/min
Dosages for dialysis
intermittent haemodialysis	seek expert advice
peritoneal dialysis
continuous renal replacement therapy
fosfomycin (single-dose oral therapy)
Dosage adjustment based on GFR [NB2]
more than 50 mL/min	normal
10 to 50 mL/min	normal
less than 10 mL/min	normal
Dosages for dialysis [NB2]
intermittent haemodialysis	normal
peritoneal dialysis	normal
continuous renal replacement therapy	normalGattringer 2006
fusidate sodium
Dosage adjustment based on GFR [NB2]
more than 50 mL/min	normal
10 to 50 mL/min	normal
less than 10 mL/min	normal
Dosages for dialysis [NB2]
intermittent haemodialysis	normal
peritoneal dialysis	normal
continuous renal replacement therapy	normal
Note: GFR = glomerular filtration rate NB1: Dosing in patients with kidney impairment is complex. This table is intended as a guide only, see General considerations for antimicrobial dosage modification in kidney impairment. If relevant, see Dialysis and continuous renal replacement therapy for further guidance on using this table. NB2: ‘Normal’ indicates that the standard dosage regimen for the specific indication in these guidelines should be used. NB3: For multiple-daily doses, percentage dosage adjustments are calculated using the intermittent dose rather than the total daily dose (eg if standard dosing for drug X is 500 mg 6-hourly, then 50% at normal dosing interval = 250 mg 6-hourly, and 100% 12-hourly = 500 mg 12-hourly).