Table 7 Antibiotic Dose Adjustment in Patients with Renal Impairment
Antibiotic CrCl (mL/min) Dose adjustment
Amikacin 40 15 mg/kg/24 hr
30–39 15 mg/kg/36 hr
20–29 15 mg/kg/48 hr
< 20 7.5 mg/kg1 & consult kinetics
Ampicillin/sulbactam > 30 Normal dose IV q6h
15–30 Normal dose IV q12h
< 15 Normal dose IV q24h
Cefepime > 60 No adjustment
30–60 1–2 g/24 hr
11–29 500 mg–1 g/24 hr
< 11 250–500 mg/24 hr
Ceftazidime > 50 1–2g/8 hr
10–50 1–2g/12 hr
< 10 1 g/24–48 hr
Ceftriaxone Adults with both kidney and liver failure should not
receive more than 2g/24 hr
Ciprofloxacin > 50 750 mg/12 hr PO
400 mg/12 hr IV
10–50 250–500 mg/12 hr PO
400 mg/18 hr IV
< 10 250–500 mg/18h po
400 mg/24h iv
Doripenem > 50 No adjustment
30–50 250 mg/8 hr infused over 1 hr
10–30 250 mg/12 hr infused over 1 hr
Ertapenem > 31 No adjustment
30 500 mg/24 hr IV–IM
Gentamicin 50 5 mg/kg/24 hr
30–49 5 mg/kg/36 hr
20–29 5 mg/kg/48 hr
< 20 2 mg/kg1 & consult kinetics
Imipenem 71 70 kg: 500 mg/6 hr
60–69 kg: 500 mg/8 hr
50–59 kg: 250 mg/6 hr
40–49 kg: 250 mg/6 hr
30–39 kg: 250 mg/8 hr
41–70 70 kg: 500 mg/8 hr
60–69 kg: 250 mg/6 hr
50–59 kg: 250 mg/6 hr
40–49 kg: 250 mg/8 hr
30–39 kg 125 mg/6 hr
21–40 70 kg: 250 mg/6 hr
60–69 kg: 250 mg/8 hr
50–59 kg: 250 mg/8 hr
40–49 kg: 250 mg/12 hr
30–39 kg: 125 mg/8 hr
6–20 70 kg: 250 mg/12 hr
60–69 kg: 250 mg/12 hr
50–59 kg: 250 mg/12 hr
40–49 kg: 250 mg/12 hr
30–39 kg: 125 mg/12 hr
Patients with CrCl5 mL/min should not receive imipenem/
cilastatin unless dialysis is programmed within 48 hr. These
patients may be at an increased risk of seizures.
Levofloxacin > 50 500 mg/24 hr
20–49 500 mg/48 hr
< 20 500 mg1, then 250 mg/48 hr
Linezolid No adjustment
Meropenem > 50 No adjustment
26–50 Normal dose q12h
10–25 50% normal dose q12h
< 10 50% normal dose q24h
194 Bouza and Burillo