Intravenous antimicrobial dosage adjustments in
The dosing tables below
reflects current practice in Liverpool FT and is based on a combination of the
following reference sources and clinical experience: The Renal Drug Handbook
(Online), Individual Summary of Product Characteristics (SPC) and British
National Formulary (Online). The following guidance is for intravenous antimicrobials only.
First doses of antibiotics can often be given at full
treatment dosages as explained previously. Patients who are extremely unwell or
immunosuppressed may need doses at the higher end of the ranges stated. Do not
wait (e.g. until after dialysis) to administer antibiotics if patient is acutely
In Acute Kidney Injury (AKI) on Chronic Kidney Disease (CKD) associated with
sepsis, the initial dosing regimen should be according to the baseline level of
renal function. It should be noted that
haemodiafiltration (HDF) removes drugs more efficiently than HD, although there
is limited information on this.
Further information can be found in the following document: Intravenous antimicrobial dosing in renal impairment guide.pdf
There is a traffic light coding system for dose adjustments
of antimicrobials in AKI or CKD.
No dose adjustment needed in AKI
Dose adjustment generally required in CKD patients. In patients with new renal dysfunction or AKI, the
antimicrobial should be dose based on baseline kidney function (Creatinine clearance) for the
first 48 hours.
A single loading dose may be appropriate in some cases of
severe infection to ensure therapeutic drug levels, consult with microbiology
or pharmacy for advice. After 48 hours, the kidney function should be
reassessed and if no recovery of function, a dose reduction based on current
GFR is advised.
This category of antimicrobials
should be cautioned in AKI. Medication in this group can result in:
Sub-therapeutic levels in AKI (e.g.
Nephrotoxicity and should be avoided unless no
other alternatives exist (e.g. aminoglycosides)
Accumulation and therefore an immediate dose
reduction is required (e.g. vancomycin)
Adverse drug reactions such as peripheral
For further information on any of the below antimicrobials
please review monograph on the renal drug database, available via: https://renaldrugdatabase.com/.
Username and password available via library services on the intranet. Or via the summary of product characteristics
available via: https://www.medicines.org.uk/emc