Antimicrobial dosages for adults with impaired kidney function: M

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: M
[NB1]
maraviroc mebendazole mefloquine meropenem	metronidazole micafungin minocycline moxifloxacin
maraviroc
Dosage adjustment based on GFR
more than 50 mL/min	refer to product information
10 to 50 mL/min
less than 10 mL/min
Dosages for dialysis
intermittent haemodialysis	refer to product information
peritoneal dialysis	no data
continuous renal replacement therapy	no data
mebendazole
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
mefloquine
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
meropenem
Dosage adjustment based on GFR [NB2] [NB3]
more than 50 mL/min	normal
26 to 50 mL/min	100% 8- to 12-hourly
10 to 25 mL/min	50% 8- to 12-hourly
less than 10 mL/min	50 to 100% 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	50 to 100% 8-hourly [NB4]
metronidazole
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
micafungin
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
minocycline
Dosage adjustment based on GFR [NB2]
more than 50 mL/min	normal
30 to 50 mL/min	normal
less than 30 mL/min	use alternative; if essential, normal
Dosages for dialysis [NB2]
intermittent haemodialysis	use alternative; if essential, normal
peritoneal dialysis
continuous renal replacement therapy
moxifloxacin
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
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: Meropenem dosing recommendations for patients using continuous renal replacement therapy vary depending on modality and dialysate or filtration rates used – seek expert advice. For critically ill patients where expert advice is unavailable, 100% 8-hourly can be used.