Antimicrobial dosages for adults with impaired kidney function: L

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: L
[NB1]
lamivudine lamivudine+dolutegravir (Dovato) lamivudine+zidovudine (Combivir) levofloxacin (treatment of Helicobacter pylori) lincomycin	linezolid lopinavir+ritonavir (Kaletra)
lamivudine
Dosage adjustment based on GFR [NB2]
more than 50 mL/min	normal
less than 50 mL/min	see product information
Dosages for dialysis
intermittent haemodialysis	see product information
peritoneal dialysis	as for GFR 5 to 14 mL/min; see product information
continuous renal replacement therapy	HIV: 100 mg initially, then 50 mg 24-hourly
lamivudine+dolutegravir (Dovato)
Dosage adjustment based on GFR [NB2]
more than 50 mL/min	normal
30 to 50 mL/min	normal; monitor for lamivudine related adverse effects
less than 30 mL/min	avoid fixed-dose combination; see individual drugs
Dosages for dialysis
intermittent haemodialysis	avoid fixed-dose combination; see individual drugs
peritoneal dialysis
continuous renal replacement therapy
lamivudine+zidovudine (Combivir)
Dosage adjustment based on GFR [NB2]
more than 50 mL/min	normal
10 to 50 mL/min	avoid fixed-dose combination; see individual drugs
less than 10 mL/min	avoid fixed-dose combination; see individual drugs
Dosages for dialysis
intermittent haemodialysis	avoid fixed-dose combination; see individual drugs
peritoneal dialysis
continuous renal replacement therapy
levofloxacin (treatment of Helicobacter pylori) [NB4]
Dosage adjustment based on GFR
more than 50 mL/min	normal
20 to 50 mL/min	250 mg 24 hourly
less than 20 mL/min	250 mg 48 hourly
Dosages for dialysis
intermittent haemodialysis	250 mg 48 hourly given after dialysis
peritoneal dialysis	250 mg 48 hourly
continuous renal replacement therapy	250 mg 24 hourly
lincomycin
Dosage adjustment based on GFR [NB2] [NB3]
more than 50 mL/min	normal
30 to 50 mL/min	100% 8- to 12-hourly
10 to 29 mL/min	avoid; consider using clindamycin as an alternative. If essential, use 100% 8- to 12-hourly
less than 10 mL/min	avoid; consider using clindamycin as an alternative. If essential, use 100% 12- to 24-hourly
Dosages for dialysis
intermittent haemodialysis	as for GFR less than 10 mL/min; dose after dialysis if dosed 24-hourly
peritoneal dialysis	as for GFR less than 10 mL/min
continuous renal replacement therapy	as for GFR 10 to 50 mL/min
linezolid
Dosage adjustment based on GFR [NB2] [NB3]
more than 30 mL/min	normal
10 to 30 mL/min	600 mg 12-hourly for 2 days, then 300 mg 12-hourly [NB5]Kawasuji 2021
less than 10 mL/min	100% 24-hourly [NB6]Gervasoni 2015 Sasaki 2011 Tsuji 2017
Dosages for dialysis [NB2]
intermittent haemodialysis	as for GFR less than 10 mL/min; dose after dialysis [NB6]Gervasoni 2015 Sasaki 2011 Tsuji 2017
peritoneal dialysis	as for GFR less than 10 mL/min [NB6]
continuous renal replacement therapy	normal
lopinavir+ritonavir (Kaletra)
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). NB4: Seek expert advice for levofloxacin dosage adjustment in patients with infections caused by Pseudomonas aeruginosa or stenotrophomonas, or for use in the treatment of tuberculosis. NB5: Close clinical monitoring and dose adjustment is required – see Monitoring linezolid blood concentrations. NB6: Some centres do not adjust linezolid dosages for patients with GFR less than 10 mL/min, or who are undergoing intermittent haemodialysis or peritoneal dialysis. If the dosage is not adjusted, the resultant concentrations of linezolid and its metabolites can be associated with toxicity – close clinical monitoring is required (see Monitoring linezolid blood concentrations).