Antimicrobial dosages for adults with impaired kidney function: R

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: R
[NB1]
raltegravir rifabutin rifampicin rifapentine rifaximin rilpivirine ritonavir
raltegravir
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
intermittent haemodialysis	no data
peritoneal dialysis	no data
continuous renal replacement therapy	no data
rifabutin
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
rifampicin
Dosage adjustment based on GFR [NB2] [NB3]
more than 50 mL/min	normal
10 to 50 mL/min	normal
less than 10 mL/min	50 to 100% at normal dosing interval
Dosages for dialysis
intermittent haemodialysis	as for GFR less than 10 mL/min
peritoneal dialysis
continuous renal replacement therapy
rifapentine
Dosage adjustment based on GFR [NB2]
more than 50 mL/min	normal
10 to 50 mL/min	normal
less than 10 mL/min	normal [NB4]
Dosages for dialysis [NB2]
intermittent haemodialysis	normal [NB4]
peritoneal dialysis	normal [NB4]
continuous renal replacement therapy	normal [NB4]
rifaximin
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
rilpivirine
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
ritonavir
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: In patients undergoing dialysis, there is an increased incidence of rifapentine related adverse effects. Rifapentine may be used at the normal dosage for the treatment of latent tuberculosis but close monitoring for adverse effects is requiredLin 2019 Lin 2021.