Antimicrobial dosages for adults with impaired kidney function: T
This table gives dosing recommendations for adults with impaired kidney function. For antimicrobial dosing in children with impaired kidney function, seek expert advice.
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tenofovir alafenamide+emtricitabine+bictegravir (Biktarvy) tenofovir alafenamide+emtricitabine+ darunavir+cobicistat (Symtuza) tenofovir alafenamide+emtricitabine+elvitegravir+cobicistat (Genvoya) tenofovir disoproxil fumarate+emtricitabine (Truvada) tenofovir disoproxil fumarate+emtricitabine+elvitegravir+cobicistat (Stribild) tenofovir disoproxil fumarate+emtricitabine+rilpivirine (Eviplera) |
tenofovir disoproxil maleate+emtricitabine (Tenofovir Disoproxil Emtricitabine Viatris 300/200) tenofovir disoproxil phosphate tenofovir disoproxil phosphate+emtricitabine (Tenofovir EMT GH) tenofovir disoproxil succinate+emtricitabine trimethoprim+sulfamethoxazole (standard treatment dosing) trimethoprim+sulfamethoxazole (treatment of Pneumocystis jirovecii pneumonia) trimethoprim+sulfamethoxazole (prophylaxis of Pneumocystis jirovecii pneumonia) |
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teicoplanin [NB2] | |
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Dosage adjustment based on GFR [NB3] [NB4] | |
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more than 60 mL/min |
normal |
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40 to 60 mL/min |
100% 48-hourly or 50% 24-hourly |
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less than 40 mL/min |
100% 72-hourly |
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Dosages for dialysis | |
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intermittent haemodialysis |
as for GFR less than 40 mL/min |
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peritoneal dialysis | |
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continuous renal replacement therapy |
as for GFR 40 to 60 mL/min |
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tenofovir alafenamideCustodio 2016 | |
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Dosage adjustment based on GFR [NB3] | |
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more than 50 mL/min |
normal |
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15 to 50 mL/min |
normal |
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less than 15 mL/min |
avoid |
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Dosages for dialysis | |
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intermittent haemodialysis |
avoid |
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peritoneal dialysis |
avoid |
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continuous renal replacement therapy |
avoid |
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tenofovir alafenamide+emtricitabine+bictegravir (Biktarvy) | |
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Dosage adjustment based on GFR [NB3] | |
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more than 50 mL/min |
normal |
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30 to 50 mL/min |
normal |
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less than 30 mL/min |
avoid fixed-dose combination |
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Dosages for dialysis [NB3] | |
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intermittent haemodialysis |
normal; dose after dialysis on dialysis days |
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peritoneal dialysis |
avoid fixed-dose combination |
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continuous renal replacement therapy | |
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tenofovir alafenamide+emtricitabine+darunavir+cobicistat (Symtuza) | |
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Dosage adjustment based on GFR [NB3] | |
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more than 50 mL/min |
normal |
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30 to 50 mL/min |
normal |
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less than 30 mL/min |
avoid fixed-dose combination |
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Dosages for dialysis | |
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intermittent haemodialysis |
avoid fixed-dose combination |
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peritoneal dialysis | |
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continuous renal replacement therapy | |
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tenofovir alafenamide+emtricitabine+elvitegravir+cobicistat (Genvoya) | |
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Dosage adjustment based on GFR [NB3] | |
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more than 50 mL/min |
normal |
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30 to 50 mL/min |
normal |
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less than 30 mL/min |
avoid fixed-dose combination |
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Dosages for dialysis | |
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intermittent haemodialysis |
may be used under specialist advice [NB5] |
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peritoneal dialysis |
avoid fixed-dose combination |
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continuous renal replacement therapy | |
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tenofovir disoproxil fumarate | |
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Dosage adjustment based on GFR [NB3] [NB4] | |
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50 mL/min or more |
normal |
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30 to 49 mL/min |
100% 48-hourly |
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10 to 29 mL/min |
100% 72- to 96-hourly |
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less than 10 mL/min |
100% weekly |
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Dosages for dialysis | |
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intermittent haemodialysis |
as for GFR less than 10 mL/min; dose after dialysis |
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peritoneal dialysis |
as for GFR less than 10 mL/min |
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continuous renal replacement therapy |
as for GFR 10 to 29 mL/min |
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tenofovir disoproxil fumarate+emtricitabine (Truvada)Panel on Antiretroviral Guidelines for Adults and Adolescents 2024 | |
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Dosage adjustment based on GFR [NB3] [NB4] | |
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50 mL/min or more |
normal |
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30 to 49 mL/min |
100% 48-hourly |
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less than 30 mL/min |
avoid fixed-dose combination; see individual drugs |
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Dosages for dialysis | |
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intermittent haemodialysis |
avoid fixed-dose combination; see individual drugs |
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peritoneal dialysis | |
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continuous renal replacement therapy | |
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tenofovir disoproxil fumarate+emtricitabine+elvitegravir+cobicistat (Stribild) | |
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Dosage adjustment based on GFR [NB3] | |
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more than 70 mL/min |
normal |
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50 to 70 mL/min |
initiation not recommended; continue and monitor if already using |
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10 to 50 mL/min |
avoid fixed-dose combination |
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less than 10 mL/min | |
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Dosages for dialysis | |
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intermittent haemodialysis |
avoid fixed-dose combination |
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peritoneal dialysis | |
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continuous renal replacement therapy | |
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tenofovir disoproxil fumarate+emtricitabine+rilpivirine (Eviplera)Panel on Antiretroviral Guidelines for Adults and Adolescents 2024 | |
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Dosage adjustment based on GFR [NB3] | |
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more than 50 mL/min |
normal |
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10 to 50 mL/min |
avoid fixed-dose combination; see individual drugs |
less than 10 mL/min | |
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Dosages for dialysis | |
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intermittent haemodialysis |
avoid fixed-dose combination; see individual drugs |
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peritoneal dialysis | |
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continuous renal replacement therapy | |
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tenofovir disoproxil maleate | |
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Dosage adjustment based on GFR [NB3] [NB4] | |
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50 mL/min or more |
normal |
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30 to 49 mL/min |
100% 48-hourly |
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10 to 29 mL/min |
100% 72- to 96-hourly |
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less than 10 mL/min |
100% weekly |
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Dosages for dialysis | |
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intermittent haemodialysis |
as for GFR less than 10 mL/min; dose after dialysis |
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peritoneal dialysis |
as for GFR less than 10 mL/min |
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continuous renal replacement therapy |
as for GFR 10 to 29 mL/min |
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tenofovir disoproxil maleate+emtricitabine (Tenofovir Disoproxil Emtricitabine Viatris 300/200) | |
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Dosage adjustment based on GFR [NB3] [NB4] | |
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60 mL/min or more |
normal |
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30 to 59 mL/min |
100% 48-hourly |
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less than 30 mL/min |
avoid fixed-dose combination; see individual drugs |
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Dosages for dialysis | |
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intermittent haemodialysis |
avoid fixed-dose combination; see individual drugs |
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peritoneal dialysis | |
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continuous renal replacement therapy | |
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tenofovir disoproxil phosphate | |
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Dosage adjustment based on GFR [NB3] [NB4] | |
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50 mL/min or more |
normal |
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30 to 49 mL/min |
100% 48-hourly |
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10 to 29 mL/min |
100% 72- to 96-hourly |
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less than 10 mL/min |
100% weekly |
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Dosages for dialysis | |
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intermittent haemodialysis |
as for GFR less than 10 mL/min; dose after dialysis |
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peritoneal dialysis |
as for GFR less than 10 mL/min |
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continuous renal replacement therapy |
as for GFR 10 to 29 mL/min |
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tenofovir disoproxil phosphate+emtricitabine (Tenofovir EMT GH) | |
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Dosage adjustment based on GFR [NB3] [NB4] | |
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60 mL/min or more |
normal |
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30 to 59 mL/min |
100% 48-hourly |
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less than 30 mL/min |
avoid fixed-dose combination; see individual drugs |
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Dosages for dialysis | |
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intermittent haemodialysis |
avoid fixed-dose combination; see individual drugs |
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peritoneal dialysis | |
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continuous renal replacement therapy | |
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tenofovir disoproxil succinate+emtricitabine | |
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Dosage adjustment based on GFR [NB3] [NB4] | |
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more than 60 mL/min |
normal |
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30 to 59 mL/min |
100% 48-hourly |
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less than 30 mL/min |
avoid fixed-dose combination; see individual drugs |
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Dosages for dialysis | |
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intermittent haemodialysis |
avoid fixed-dose combination; see individual drugs |
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peritoneal dialysis | |
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continuous renal replacement therapy | |
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terbinafine | |
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Dosage adjustment based on GFR [NB3] [NB4] | |
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more than 50 mL/min |
normal |
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10 to 50 mL/min |
100% 48-hourly |
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less than 10 mL/min | |
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Dosages for dialysis | |
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intermittent haemodialysis |
as for GFR less than 10 mL/min; dose after dialysis |
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peritoneal dialysis |
as for GFR less than 10 mL/min |
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continuous renal replacement therapy | |
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tetracycline | |
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Dosage adjustment based on GFR [NB2] [NB3] | |
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more than 60 mL/min |
normal |
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30 to 59 mL/min |
100% 12 hourly |
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less than 30 mL/min |
avoid |
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Dosages for dialysis [NB2] | |
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intermittent haemodialysis |
avoid |
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peritoneal dialysis |
avoid |
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continuous renal replacement therapy |
avoid |
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tinidazole | |
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Dosage adjustment based on GFR [NB3] | |
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more than 50 mL/min |
normal |
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10 to 50 mL/min |
normal |
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less than 10 mL/min |
normal |
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Dosages for dialysis [NB3] | |
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intermittent haemodialysis |
normal; dose after dialysis |
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peritoneal dialysis |
normal |
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continuous renal replacement therapy |
normal |
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tipranavir | |
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Dosage adjustment based on GFR [NB3] | |
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more than 50 mL/min |
normal |
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10 to 50 mL/min |
normal |
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less than 10 mL/min |
normal |
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Dosages for dialysis [NB3] | |
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intermittent haemodialysis |
normal |
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peritoneal dialysis |
normal |
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continuous renal replacement therapy |
normal |
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tobramycin | |
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Dosage adjustment based on GFR | |
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more than 50 mL/min | |
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10 to 50 mL/min | |
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less than 10 mL/min | |
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Dosages for dialysis | |
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intermittent haemodialysis |
seek expert advice |
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peritoneal dialysis | |
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continuous renal replacement therapy | |
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triclabendazole | |
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Dosage adjustment based on GFR | |
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more than 50 mL/min |
no data |
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10 to 50 mL/min |
no data |
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less than 10 mL/min |
no data |
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Dosages for dialysis | |
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intermittent haemodialysis |
no data |
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peritoneal dialysis |
no data |
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continuous renal replacement therapy |
no data |
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trimethoprim | |
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Dosage adjustment based on GFR [NB3] | |
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more than 30 mL/min |
normal |
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15 to 30 mL/min |
normal; monitor full blood count and urea and electrolytes |
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less than 15 mL/min |
avoid; if essential, up to 150 mg 24-hourly; monitor full blood count |
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Dosages for dialysis [NB3] | |
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intermittent haemodialysis |
as for GFR less than 15 mL/min; dose after dialysis |
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peritoneal dialysis |
as for GFR less than 15 mL/min |
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continuous renal replacement therapy |
normal |
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trimethoprim+sulfamethoxazole (standard treatment dosing) | |
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Dosage adjustment based on GFR [NB3] [NB4] | |
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more than 50 mL/min |
normal |
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26 to 50 mL/min |
normal for 14 days, then 50% at normal dosing interval |
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15 to 25 mL/min |
normal for 3 days, then 100% 24-hourly |
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less than 15 mL/min |
avoid; if essential, normal for 3 days, then 100% 24-hourly |
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Dosages for dialysis | |
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intermittent haemodialysis |
as for GFR less than 15 mL/min; dose after dialysis if dosed 24-hourly |
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peritoneal dialysis |
as for GFR less than 15 mL/min |
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continuous renal replacement therapy |
as for GFR 15 to 25 mL/min |
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trimethoprim+sulfamethoxazole (treatment of Pneumocystis jirovecii pneumonia) | |
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Dosage adjustment based on GFR [NB3] | |
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more than 50 mL/min |
normal |
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26 to 50 mL/min |
normal |
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15 to 25 mL/min |
5+25 mg/kg at normal dosing interval for 2 days, then 5+25 mg/kg 12-hourly |
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less than 15 mL/min |
5+25 mg/kg 12- to 24-hourly |
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Dosages for dialysis | |
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intermittent haemodialysis |
as for GFR less than 15 mL/min; dose after dialysis if dosed 24-hourly |
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peritoneal dialysis |
as for GFR less than 15 mL/min |
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continuous renal replacement therapy |
as for GFR 15 to 25 mL/min |
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trimethoprim+sulfamethoxazole (prophylaxis of Pneumocystis jirovecii pneumonia) | |
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Dosage adjustment based on GFR | |
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more than 50 mL/min |
practices vary – refer to local protocol or seek expert advice |
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26 to 50 mL/min | |
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15 to 25 mL/min | |
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less than 15 mL/min | |
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Dosages for dialysis | |
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intermittent haemodialysis |
practices vary – refer to local protocol or seek expert advice |
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peritoneal dialysis | |
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continuous renal replacement therapy | |
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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: Use normal dose for the first 3 days then adjust dosing on day 4. If possible, monitor the teicoplanin blood concentration. NB3: ‘Normal’ indicates that the standard dosage regimen for the specific indication in these guidelines should be used. NB4: 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). NB5: A recent study showed that the combination product containing tenofovir alafenamide+emtricitabine+elvitegravir+cobicistat (Genvoya) is not associated with increased adverse effects in patients on haemodialysis despite increased concentrations of tenofovir and emtricitabine being present. | |