Antimicrobial dosages for adults with impaired kidney function: A
This table gives dosing recommendations for adults with impaired kidney function. For antimicrobial dosing in children with impaired kidney function, seek expert advice.
|
abacavir | |
|
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 |
|
abacavir+lamivudine (Kivexa) | |
|
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 | |
|
Dosages for dialysis | |
|
intermittent haemodialysis |
avoid fixed-dose combination; see individual drugs |
|
peritoneal dialysis | |
|
continuous renal replacement therapy | |
|
aciclovir intravenous | |
|
Dosage adjustment based on GFR [NB2] [NB3] | |
|
more than 50 mL/min |
normal |
|
25 to 50 mL/min |
100% 12-hourly |
|
10 to 24 mL/min |
100% 24-hourly |
|
less than 10 mL/min |
50% 24-hourly |
|
Dosages for dialysis | |
|
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 |
5 to 10 mg/kg 24-hourly |
|
aciclovir oral | |
|
Dosage adjustment based on GFR [NB2] | |
|
more than 50 mL/min |
normal |
|
10 to 50 mL/min |
dosage depends on the indication and patient’s immune status; see product information |
|
less than 10 mL/min | |
|
Dosages for dialysis | |
|
intermittent haemodialysis | dosage depends on the indication and patient’s immune status; see product information |
|
peritoneal dialysis | |
|
continuous renal replacement therapy | |
|
adefovir | |
|
Dosage adjustment based on GFR | |
|
more than 50 mL/min |
normal |
|
30 to 49 mL/min |
100% 48-hourly |
|
10 to 29 mL/min |
100% 72-hourly |
|
less than 10 mL/min |
no data |
|
Dosages for dialysis | |
|
intermittent haemodialysis |
100% every 7 days after dialysis |
|
peritoneal dialysis |
no data |
|
continuous renal replacement therapy |
no data |
|
albendazole | |
|
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 |
|
amikacin | |
|
Dosage adjustment based on GFR | |
|
more than 50 mL/min | see Principles of aminoglycoside use |
|
10 to 50 mL/min | |
|
less than 10 mL/min | |
|
Dosages for dialysis | |
|
intermittent haemodialysis |
seek expert advice |
|
peritoneal dialysis | |
|
continuous renal replacement therapy | |
|
amoxicillinHumbert 1979Smit 2022 | |
|
Dosage adjustment based on GFR [NB2] [NB3] | |
|
more than 50 mL/min |
normal |
|
31 to 50 mL/min |
100% 6-hourly |
|
10 to 30 mL/min |
100% 8-hourly |
|
less than 10 mL/min |
100% 12-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 31 to 50 mL/min |
|
amoxicillin+clavulanate intravenous | |
|
Dosage adjustment based on GFR [NB2] | |
|
more than 50 mL/min |
normal |
|
30 to 50 mL/min |
normal |
|
less than 30 mL/min |
1+0.2 g 12-hourly |
|
Dosages for dialysis | |
|
intermittent haemodialysis |
1+0.2 g 12-hourly, or loading dose of 1+0.2 g, then 500+125 mg 8-hourlyDe Schuyter 2021 |
|
peritoneal dialysis |
as for GFR less than 30 mL/min |
|
continuous renal replacement therapy |
as for GFR less than 30 mL/min |
|
amoxicillin+clavulanate oral | |
|
Dosage adjustment based on GFR [NB2] | |
|
more than 50 mL/min |
normal |
|
30 to 50 mL/min |
normal |
|
less than 30 mL/min |
short treatment duration: normal prolonged treatment duration: consider dose reduction to 500+125 mg 12-hourly |
|
Dosages for dialysis [NB2] | |
|
intermittent haemodialysis |
as for GFR less than 30 mL/min |
|
peritoneal dialysis | |
|
continuous renal replacement therapy |
normal |
|
amphotericin B desoxycholate | |
|
Dosage adjustment based on GFR [NB2] | |
|
more than 50 mL/min |
normal |
|
10 to 50 mL/min |
avoid; consider using a lipid formulation. If essential, normal |
|
less than 10 mL/min | |
|
Dosages for dialysis [NB2] | |
|
intermittent haemodialysis |
if essential, normal (avoid during acute kidney injury) |
|
peritoneal dialysis | |
|
continuous renal replacement therapy | |
|
amphotericin B liposomal | |
|
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 |
|
ampicillinHumbert 1979 | |
|
Dosage adjustment based on GFR [NB2] [NB3] | |
|
more than 50 mL/min |
normal |
|
31 to 50 mL/min |
100% 6-hourly |
|
10 to 30 mL/min |
100% 8-hourly |
|
less than 10 mL/min |
100% 12-hourly |
|
Dosages for dialysis | |
|
intermittent haemodialysis |
as for GFR less than 10 mL/min |
|
peritoneal dialysis | |
|
continuous renal replacement therapy |
as for GFR 31 to 50 mL/min |
|
anidulafungin | |
|
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 |
|
artemether+lumefantrine | |
|
Dosage adjustment based on GFR [NB2] | |
|
more than 50 mL/min |
normal |
|
10 to 50 mL/min |
normal |
|
less than 10 mL/min |
normal (monitor ECG and blood potassium concentration) |
|
Dosages for dialysis [NB2] | |
|
intermittent haemodialysis |
normal (monitor ECG and blood potassium concentration) |
|
peritoneal dialysis | |
|
continuous renal replacement therapy |
no data |
|
artesunate | |
|
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 |
normal |
|
peritoneal dialysis |
normal |
|
continuous renal replacement therapy |
normal |
|
atazanavir+cobicistat (Evotaz) | |
|
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 |
see product information |
|
peritoneal dialysis |
normal |
|
continuous renal replacement therapy |
normal |
|
atovaquone | |
|
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 |
|
atovaquone+proguanil | |
|
Dosage adjustment based on GFR [NB2] | |
|
more than 50 mL/min |
normal |
|
30 to 50 mL/min |
normal |
|
less than 30 mL/min |
avoid |
|
Dosages for dialysis | |
|
intermittent haemodialysis |
avoid |
|
peritoneal dialysis | |
|
continuous renal replacement therapy | |
|
azithromycin | |
|
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:
ECG = electrocardiogram; 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). | |