Antimicrobial dosages for adults with impaired kidney function: B

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: B
[NB1]
baloxavir benzathine benzylpenicillin benzylpenicillin
baloxavir
Dosage adjustment based on GFR [NB2]
more than 50 mL/min	normal
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
benzathine benzylpenicillin
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	no data
benzylpenicillin
Dosage adjustment based on GFR [NB2] [NB3]
more than 50 mL/min	normal
10 to 50 mL/min	75% at normal dosing interval
less than 10 mL/min	25 to 50% at normal dosing interval (maximum of 6 g per day)Kidney Disease: Improving Global Outcomes (KDIGO) 2013
Dosages for dialysis [NB4]
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 50 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: For patients on haemodialysis who have serious infections (including endocarditis, neurosyphilis), administer up to 2 million units every 4 to 6 hours. One million units is equivalent to 600 mg of benzylpenicillin.Heintz 2009