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Urowki
Sjlee (토론 | 기여)님의 2019년 6월 26일 (수) 06:49 판 (새 문서: {| class="wikitable" !Antibiotic ! colspan="3" |GFR (mL/min) !Comments |- | |'''Mild''' 50-20 |'''Moderate''' 20-10 |'''Severe''' < 10 | |- |*Aciclovir |Normal dose every 12h |normal...)
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Antibiotic GFR (mL/min) Comments
Mild

50-20

Moderate

20-10

Severe

< 10

*Aciclovir Normal dose every 12h normal dose every 24h 50% of normal dose every 24h Give postHD
Aciclovir po normal Herpes simplex: normal Herpes zoster: 800mg Total Dissolved Solids tds Herpes simplex: 200mg bid Herpes zoster: 800 mg bd Give postHD
Amikacin 5-6mg/kg 12h 3-4mg/ kg 24h HD: 5mg/ kg post HD and monitor levels 2mg/kg 24-48h Give post-HD Monitor preand 1h postdose levels after 3rd dose and adjust dose as required
Amoxicillin po normal normal 250mg 8h (normal) Give postHD
Amphotericin normal normal normal
(Liposonal+ lipid complex) Amphotericin is highly NEPHROTOXIC. Consider using liposomal/lipid complex amphotericin. Daily monitoring of renal function (GFR) essential.
Ampicillin IV normal  250-500mg 6h 250mg 6h (500mg 6h) Give postHD
Benzylpenicillin Normal  75%  0-50% Max. 3.6g/ day (1.2g qds) Give postHD Refer to microbiology for dosing in SBE
Caspofungin normal normal normal
Cefotaxime normal normal 1g stat then 50% Give postHD
Cefradine normal normal 250mg 6h Give postHD
Ceftazidime 1g 12h 1g 24h 500mg 24h (1g 24h) Give postHD
Ceftriaxone normal normal normal Max. 2g/day
Cefuroxime IV normal 750mg-1.5g 12h 750mg 24h (750mg 12h) Give postHD
Ciproflazin IV+po normal 50% 50%
Clarithromycin IV+po normal normal 50% Give postHD
Clindamycin IV+po normal normal normal
Coamoxiclav IV (Augmentin) normal 1.2 stat then 50% 12h (1.2g 12h) 1.2 stat then 50% 24h (1.2g stat then 600mg 12h) Give postHD
Coamoxiclav po (Augmentin) normal 375-625mg 12h (375mg 8h) 375mg 12h (375mg 8h) Give postHD
Cotrimoxazole IV normal Normal for 3/7 then 50% 50% Give postHD
Doxycycline contraindicated normal normal normal All other tetracyclines contraindicated in renal impairment
Erythromycin IV+po normal normal normal Max. 1.5g/ day (500mg qds) *
*Ethambutol normal 24-36h 48h Give postHD
Monitor levels if GFR < 30mL/min (contact Mirco)
Flucloxacillin IV+po normal normal normal Max. 4g/day
Fluconazole normal normal 50% Give post-HD No adjustments in single-dose therapy required
*Flucytosine 50mg/kg 12h 50mg/kg 24h 50mg/kg stat thendose according to levels Give post-HD Levels should be monitored predialysis.
Fusidic acid normal normal normal
1) Gentamicin ONCE DAILY GFR 10-40mL/min

3mg/kg stat (max. 300mg) Check pre-dose levels 18- 24h after

first dose

Redose only when level < 1mg/L

GFR < 10mL/ min

2mg/kg (max. 200mg) redose according to levels

BOTH METHODS Give postHD

Monitor blood levels:

2) Gentamicin CONVENTIONAL 80mg 12h 80mg 48h  80mg 24h HD: 1-2mg/ kg

Post-HD: redose according to levels

Once daily: pre only

Conventional: pre and 1 h post level required.

Imipenem 500mg 8-12h 250-500mg bid Risk of convulsions - use Meropenem: see below Give postHD
Isoniazid normal normal 200-300mg 24h Give postHD
Itraconazole normal normal normal
Levoflaxacin 500mg stat then 250mg bid** 500mg stat then 125mg bid** 500mg stat then 125mg od **Applies if full dose is 500 mg bid If full dose is 500 mg od, five reduced doses daily
Linezolid normal normal normal Give postHD
Meropenem 12h 50% 12h 50% 24h Give postHD
Metronidazole normal normal 12h (normal) Give postHD
Nitrofurantoin Do NOT use in renal impairment
Penicillin V normal normal normal Give postHD
Piperacillin/ Tazobactam (Tazocin) 4.5g 8h 4.5g 12h 4.5g 12h Give postHD
Pyrazinamide normal normal normal
Rifampicin normal normal 50-100%
*Teicoplanin 100% 48h 100% 72h 100% 72h Dose reduction after day 3 of therapy