Drug | CrCl (mL/minute) | Adult dose | Frequency |
Beta-lactamase inhibitor combinations | |||
Ampicillin-sulbactam (mild to moderate infections) | ≥30 | 1.5 g | Every 6 hours |
15 to 29 | 1.5 g | Every 12 hours | |
5 to 14 | 1.5 g | Every 24 hours | |
iHD* | 1.5 g | Every 12 to 24 hours | |
CRRT¶[1] | 1.5 g | Every 6 to 12 hours | |
Ampicillin-sulbactam (moderate to severe infections) | ≥30 | 3 g | Every 6 hours |
15 to 29 | 3 g | Every 12 hours | |
5 to 14 | 3 g | Every 24 hours | |
iHD* | 3 g | Every 12 to 24 hours | |
CRRT¶[1] | 3 g | Every 6 to 12 hours | |
Ceftazidime-avibactam | >50 | 2.5 g | Every 8 hours |
31 to 50 | 1.25 g | Every 8 hours | |
16 to 30 | 0.94 g | Every 12 hours | |
6 to 15 | 0.94 g | Every 24 hours | |
≤5 | 0.94 g | Every 48 hours | |
iHD* | 0.94 g | CrCl 6 to 15 mL/minute: Every 24 hours CrCl ≤5 mL/minute: Every 48 hours Administer after iHD on dialysis days | |
CRRT[2] (based on preliminary data) | 1.25 g | Every 8 hours | |
Ceftolozane-tazobactam (complicated UTI and intra-abdominal infections) | >50 | 1.5 g | Every 8 hours |
30 to 50 | 750 mg | Every 8 hours | |
15 to 29 | 375 mg | Every 8 hours | |
<15 | Has not been studied | ||
iHD* | 750 mg once, followed by 150 mg | Every 8 hours | |
CRRT[3] (based on preliminary data) | 750 mg | Every 8 hours | |
Ceftolozane-tazobactam (severe infections)[4,5] | >50 | 3 g | Every 8 hours |
30 to 50 | 1.5 g | Every 8 hours | |
15 to 29 | 750 mg | Every 8 hours | |
<15 | Has not been studied | ||
iHD* | 750 mg once, followed by 375 mg | Every 8 hours | |
CRRT[3] (based on preliminary data) | 1.5 g | Every 8 hours | |
Imipenem-cilastatin-relebactam | ≥90 | 1.25 g | Every 6 hours |
60 to 89 | 1 g | Every 6 hours | |
30 to 59 | 0.75 g | Every 6 hours | |
15 to 29 | 0.5 g | Every 6 hours | |
iHD* | 0.5 g | Every 6 hours; administer after iHD on dialysis days | |
Meropenem-vaborbactam NOTE: Use MDRD equation formula to estimate renal function (eGFR) | ≥50 | 4 g | Every 8 hours (infused over 3 hours) |
30 to 49 | 2 g | Every 8 hours (infused over 3 hours) | |
15 to 29 | 2 g | Every 12 hours (infused over 3 hours) | |
<15 | 1 g | Every 12 hours (infused over 3 hours) | |
iHD* | 1 g | Every 12 hours (infused over 3 hours) administered after an iHD session | |
Piperacillin-tazobactam (mild to moderate infections) | >40 | 3.375 g | Every 6 hours |
20 to 40 | 2.25 g | Every 6 hours | |
<20 | 2.25 g | Every 8 hours | |
iHD* | 2.25 g | Every 12 hours | |
CRRT¶[1] | 2.25 g | Every 6 to 8 hours | |
Piperacillin-tazobactam (severe infections, including Pseudomonas aeruginosa) | >40 | 4.5 g | Every 6 hours |
20 to 40 | 3.375 g | Every 6 hours | |
<20 | 2.25 g | Every 6 hours | |
iHD* | 2.25 g | Every 8 hours | |
CRRT¶[1] | 3.375 g | Every 6 to 8 hours | |
Sulbactam-durlobactam | ≥130 (augmented renal clearance) | Sulbactam 1 g/durlobactam 1 g | Every 4 hours |
45 to 129 | Sulbactam 1 g/durlobactam 1 g | Every 6 hours | |
30 to 44 | Sulbactam 1 g/durlobactam 1 g | Every 8 hours | |
15 to 29 | Sulbactam 1 g/durlobactam 1 g | Every 12 hours | |
<15 | Sulbactam 1 g/durlobactam 1 g | Every 12 hours for first 3 doses, then once daily (NOTE: For patients whose CrCl declines to <15 mL/minute after therapy has been initiated, administer once daily without loading dose) | |
iHD* | Sulbactam 1 g/durlobactam 1 g | Every 12 hours for first 3 doses, then once daily; administer after hemodialysis on dialysis days (NOTE: For patients who require hemodialysis after therapy has been initiated, administer once daily without loading dose) | |
Carbapenems | |||
Doripenem | >50 | 500 mg | Every 8 hours |
30 to 50 | 250 mg | Every 8 hours | |
11 to 29 | 250 mg | Every 12 hours | |
<10 | Has not been studied | ||
iHD* | 250 to 500 mg | Every 24 hours | |
CRRT¶ | 250 mg to 1 g | Every 8 to 12 hours | |
Ertapenem | >30 | 1 g | Every 24 hours |
≤30 | 500 mg | Every 24 hours | |
iHD* | 500 mg | Every 24 hours; administer after iHD on dialysis days | |
CRRT¶[6] (based on preliminary data) | 1 g | Every 24 hours | |
Imipenem-cilastatin (moderate infection)[7] | >70 to 89 | 500 mg | Every 6 hours |
41 to 70 | 500 mg | Every 8 hours | |
21 to 40 | 250 mg | Every 6 hours | |
<21 | 250 mg | Every 12 hours | |
iHD* | 250 mg | Every 12 hours; administer after iHD on dialysis days | |
CRRT¶[1] | 250 to 500 mg | Every 6 to 8 hours | |
Imipenem-cilastatin (severe infection)[7] | >70 to 89 | 1 g | Every 6Δ to 8 hours |
41 to 70 | 500 mg | Every 6 hours | |
21 to 40 | 500 mg | Every 8 hours | |
<21 | 500 mg | Every 12 hours | |
iHD* | 500 mg | Every 12 hours; administer after iHD on dialysis days | |
CRRT¶[1] | 500 mg | Every 6 to 8 hours | |
Meropenem (meningitis, cystic fibrosis pulmonary exacerbation) | >50 | 2 g | Every 8 hours |
26 to 50 | 2 g | Every 12 hours | |
10 to 25 | 1 g | Every 12 hours | |
<10 | 1 g | Every 24 hours | |
iHD* | 1 g | Every 24 hours; administer after iHD on dialysis days | |
CRRT¶[1] | 500 mg or 1 g | Every 8 to 12 hours | |
Meropenem (moderate to severe infection)◊ | >50 | 1 g | Every 8 hours |
26 to 50 | 1 g | Every 12 hours | |
10 to 25 | 500 mg | Every 12 hours | |
<10 | 500 mg | Every 24 hours | |
iHD* | 500 mg | Every 24 hours; administer after iHD on dialysis days | |
CRRT¶[1] | 500 mg or 1 g | Every 8 to 12 hours | |
Monobactam | |||
Aztreonam (moderate infection) | >30 | 1 g | Every 8 hours |
10 to 30 | 500 mg | Every 8 hours | |
<10 | 250 mg | Every 8 hours | |
iHD* | 1 g once, followed by 250 mg | Every 8 to 12 hours | |
CRRT¶[1] | 2 g once, followed by 1 or 2 g | 1 g every 8 hours or 1 to 2 g every 12 hours | |
Aztreonam (severe infection) | >30 | 2 g | Every 8 hours |
10 to 30 | 1 g | Every 8 hours | |
<10 | 500 mg | Every 8 hours | |
iHD* | 2 g once, followed by 500 mg | Every 8 hours | |
CRRT¶[1] | 2 g once, followed by 1 or 2 g | 1 g every 8 hours or 1 to 2 g every 12 hours |
This table lists doses of selected beta-lactam antibiotics, with suggested dosing adjustments for renal impairment. The first dose listed for each agent represents the suggested dose for normal renal function. Renal function is evaluated based on estimated CrCl using the Cockcroft-Gault equation. A calculator for estimating CrCl based on the Cockcroft-Gault equation is available in UpToDate.
NOTE: Doses listed for the combination beta-lactam/beta-lactamase inhibitors are expressed as the total of grams for both components.CrCl: creatinine clearance; CRRT: continuous renal replacement therapy; eGFR: estimated glomerular filtration rate; iHD: intermittent hemodialysis; MDRD: Modification of Diet in Renal Disease.
* Based on three times weekly dialysis sessions of 3 to 4 hours each; on dialysis days administer dose after dialysis. A loading dose may be warranted for some antibiotics depending on clinical scenario; refer to Lexicomp monograph for detail.
¶ General dose and interval range for different types of CRRT based on dialysate/ultrafiltration rate of 1 to 2 L/hour are listed. Specific dosing depends on CRRT method, flow rate, and filter type. For specific recommendations; refer to Lexicomp monograph included in UpToDate.
Δ An imipenem dose of 1 g given every 6 hours has been associated with an increased risk of seizures.[8]
◊ A lower dose is recommended for some skin/skin structure and urinary tract infections. Refer to Lexicomp monograph.Courtesy of Stephen B Calderwood, MD and Alyssa R Letourneau, MD, with additional data from Lexicomp Online. Copyright © 1978-2024 Lexicomp, Inc. All Rights Reserved.
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