Antimicrobial dosages for adults with impaired kidney function: I

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: I
[NB1]
imipenem+cilastatin indinavir isavuconazole isoniazid	itraconazole ivermectin
imipenem+cilastatin
dose expressed as imipenem component 500 to 1000 mg loading dose may be required
Dosage adjustment based on GFR [NB2]
more than 60 mL/min	normal
30 to 60 mL/min	500 mg 6- to 8-hourly
20 to 29 mL/min	250 mg 8-hourly to 500 mg 12-hourly
less than 20 mL/min	avoid; if essential, 250 to 500 mg 12-hourly (usually 500 mg 12-hourly)
Dosages for dialysis
intermittent haemodialysis	as for GFR less than 20 mL/min
peritoneal dialysis	no data
continuous renal replacement therapy	500 mg 6 to 8-hourlyBoucher 2016 Cotton 2005
indinavir
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
isavuconazole
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
isoniazid
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; dose after dialysis
peritoneal dialysis	normal
continuous renal replacement therapy	normal
itraconazole
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
ivermectin
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).