Antimicrobial dosages for adults with impaired kidney function: E

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: E
[NB1]
efavirenz emtricitabine emtricitabine+rilpivirine+tenofovir alafenamide (Odefsey) emtricitabine+tenofovir alafenamide (Descovy) entecavir	ertapenem erythromycin ethambutol (daily regimen) ethambutol (3-times-weekly regimen) etravirine
efavirenz
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
emtricitabine
Dosage adjustment based on GFR [NB2] [NB3]
50 mL/min or more	normal
30 to 49 mL/min	100% 48-hourly
15 to 29 mL/min	100% 72-hourly
less than 15 mL/min	100% 96-hourly
Dosages for dialysis
intermittent haemodialysis	as for GFR less than 15 mL/min; dose after dialysis
peritoneal dialysis	as for GFR less than 15 mL/min
continuous renal replacement therapy	as for GFR 30 to 49 mL/min
emtricitabine+rilpivirine+tenofovir alafenamide (Odefsey)Panel on Antiretroviral Guidelines for Adults and Adolescents 2024
Dosage adjustment based on GFR [NB2]
more than 50 mL/min	normal
30 to 50 mL/min	normal
less than 30 mL/min	avoid fixed-dose combination; see individual drugs
Dosages for dialysis
intermittent haemodialysis	avoid fixed-dose combination; see individual drugs
peritoneal dialysis
continuous renal replacement therapy
emtricitabine+tenofovir alafenamide (Descovy)
Dosage adjustment based on GFR [NB2]
more than 50 mL/min	normal
30 to 50 mL/min	normal
less than 30 mL/min	avoid fixed-dose combination; see individual drugs
Dosages for dialysis [NB2]
intermittent haemodialysis	normal; dose after dialysis (see product information)
peritoneal dialysis	avoid fixed-dose combination; see individual drugs
entecavir
Dosage adjustment based on GFR
more than 50 mL/min	see product information
30 to 50 mL/min	see product information
10 to 29 mL/min	see product information
less than 10 mL/min	see product information
Dosages for dialysis
intermittent haemodialysis	see product information
peritoneal dialysis	see product information
continuous renal replacement therapy	no data
ertapenem
Dosage adjustment based on GFR [NB2]
more than 50 mL/min	normal
30 to 50 mL/min	normal
less than 30 mL/min	500 mg 24-hourly
Dosages for dialysis [NB2]
intermittent haemodialysis	500 mg 24-hourly, dose after dialysis or 500 to 1000 mg 3 times a week post-dialysis on dialysis days. Consider patient factors (eg severity of infection, patient’s weight) when determining dose.Geerlings 2013 Hsaiky 2019 Ueng 2019
peritoneal dialysis	as for GFR less than 30 mL/min
continuous renal replacement therapy	normal
erythromycin
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 75% at normal dosing interval
Dosages for dialysis [NB2]
intermittent haemodialysis	as for GFR less than 10 mL/min
peritoneal dialysis	as for GFR less than 10 mL/min
continuous renal replacement therapy	normal
ethambutol (daily regimen)
Dosage adjustment based on GFR [NB2] [NB3]
more than 30 mL/min	normal
10 to 30 mL/min	avoid; if essential, 100% 3 times per week
less than 10 mL/min	avoid; if essential, 100% 3 times per week
Dosages for dialysis [NB3]
intermittent haemodialysis	avoid; if essential, 100% 3 times per week after dialysis
peritoneal dialysis	avoid; if essential, as for GFR less than 10 mL/min
continuous renal replacement therapy	avoid; if essential, as for GFR 10 to 30 mL/min
ethambutol (3-times-weekly regimen)
Dosage adjustment based on GFR [NB2] [NB3]
more than 30 mL/min	normal
10 to 30 mL/min	avoid; if essential, 15 mg/kg, three times per week
less than 10 mL/min	avoid; if essential, 15 mg/kg, three times per week
Dosages for dialysis [NB3]
intermittent haemodialysis	avoid; if essential, 15 mg/kg three times per week after dialysis
peritoneal dialysis	avoid; if essential, as for GFR less than 10 mL/min
continuous renal replacement therapy	avoid; if essential, as for GFR 10 to 30 mL/min
etravirine
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] [NB3]
intermittent haemodialysis	normal
peritoneal dialysis	normal
continuous renal replacement therapy	no data
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).