Antimicrobial dosages for adults with impaired kidney function: G

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: G
[NB1]
ganciclovir treatment ganciclovir prophylaxis gentamicin griseofulvin
ganciclovir treatment [NB2]
Dosage adjustment based on GFR [NB3]
70 mL/min or more	normal
50 to 69 mL/min	2.5 mg/kg 12-hourly
25 to 49 mL/min	2.5 mg/kg 24-hourly
10 to 24 mL/min	1.25 mg/kg 24-hourly
less than 10 mL/min	1.25 mg/kg 3 times weekly
Dosages for dialysis
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	as for GFR 10 to 24 mL/min
ganciclovir prophylaxis
Dosage adjustment based on GFR [NB3]
70 mL/min or more	normal
50 to 69 mL/min	2.5 mg/kg 24-hourly
25 to 49 mL/min	1.25 mg/kg 24-hourly
10 to 24 mL/min	0.625 mg/kg 24-hourly
less than 10 mL/min	0.625 mg/kg 3 times weekly
Dosages for dialysis
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	as for GFR 10 to 24 mL/min
gentamicin
Dosage adjustment based on GFR
more than 50 mL/min	see Principles of aminoglycoside use
10 to 50 mL/min
less than 10 mL/min
Dosages for dialysis
intermittent haemodialysis	seek expert advice
peritoneal dialysis
continuous renal replacement therapy
griseofulvin
Dosage adjustment based on GFR [NB3]
more than 50 mL/min	normal
10 to 50 mL/min	normal
less than 10 mL/min	normal
Dosages for dialysis [NB3]
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: Higher doses of ganciclovir may be used in patients being treated for cytomegalovirus. There is some evidence that therapeutic drug monitoring may be useful in select patient groups including patients with kidney impairment (see Monitoring antiviral blood concentrations)Franck 2022. NB3: ‘Normal’ indicates that the standard dosage regimen for the specific indication in these guidelines should be used. NB4: 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).