Antimicrobial dosages for adults with impaired kidney function: N

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: N
[NB1]
nevirapine niclosamide nitazoxanide nitrofurantoin norfloxacin
nevirapine
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 if dosed 24-hourly
peritoneal dialysis	normal
continuous renal replacement therapy	normal
niclosamide
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
nitazoxanide
Dosage adjustment based on GFR
more than 50 mL/min	no data
10 to 50 mL/min	no data
less than 10 mL/min	no data
Dosages for dialysis
intermittent haemodialysis	no data
peritoneal dialysis	no data
continuous renal replacement therapy	no data
nitrofurantoinOplinger 2013 Singh 2015
Dosage adjustment based on GFR [NB2]
more than 40 mL/min	normal
10 to 40 mL/min	avoid [NB4]
less than 10 mL/min	avoid
Dosages for dialysis
intermittent haemodialysis	avoid
peritoneal dialysis	avoid
continuous renal replacement therapy	avoid
norfloxacin
Dosage adjustment based on GFR [NB2] [NB3]
more than 30 mL/min	normal
10 to 30 mL/min	100% 12- to 24-hourly
less than 10 mL/min	100% 24-hourly
Dosages for dialysis
intermittent haemodialysis	as for GFR less than 10 mL/min
peritoneal dialysis	as for GFR less than 10 mL/min
continuous renal replacement therapy	as for GFR 10 to 30 mL/min
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: Retrospective data suggest that nitrofurantoin is safe and effective for short-term treatment (5 to 7 days) in patients with a GFR of 30 mL/min or moreCunha 2017 Geerts 2013 Santos 2016 Singh 2015.