신기능에 따른 용량 조정 편집하기

{| class="wikitable"
!Antibiotic
! colspan="3" |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)
| colspan="3" |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
|-
|
| colspan="3" |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
| colspan="2" |'''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
| colspan="2" |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
| colspan="2" |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
|}