Table 4.
Adjustment of antimicrobials according to the Glomerular Filtration Rate (GFR). Doses are provided for the treatment of E. faecalis endocarditis.
| Antimicrobial | GFR > 50 | GFR = 50–30 | GFR = 30–10 | GFR < 10 ¶ |
|---|---|---|---|---|
| Beta-lactams | ||||
| Penicillin | 4 M UI/4 h IV | 4 M UI/6 h IV | 3 M UI/8 h IV | 2 M UI/12 h IV |
| Ampicillin | 2 g/4 h IV | 2 g/6 h IV | 2 g/8 h IV | 1 g/12 h IV |
| Amoxicilin | 2 g/4 h IV 1 g/6 h po |
2 g/6 h IV 1 g/8 h po |
2 g/8 h IV 0.5–1 g/12 h po |
1 g/12 h IV 0.5–1 g/24 h po |
| Ceftriaxone | 2 g/12 h IV | 2 g/12 h IV | 2 g/12 h IV | 2 g/24 h IV |
| Ceftriboprole | 500–1000 mg/12 h IV | 500 mg/12 h IV | 250 mg/12 h IV | 250 mg/12 h IV |
| Ceftaroline | 400 mg/8–12 h IV | 400 mg/8–12 h IV | 300 mg/8–12 h IV | 200 mg/8–12 h IV |
| Imipenem | 1 g/6–8 h IV | 0.5–1 g/8 h IV | 0.5 g/8–12 h IV | 0.5 g/12 h IV |
| Meropenem | 1 g/6–8 h IV | 1 g/8 h IV | 1 g/12 h IV | 1 g/24 h IV |
| Aminoglycosides | ||||
| Gentamycin * | 3 mg/kg/24 h IV | 3 mg/kg/24–36 h IV | 3 mg/kg/48 h IV | 1–2 mg/kg/48 h IV |
| Glucopeptides | ||||
| Vancomycin * | 15–20 mg/kg/8–12 h IV | 15 mg/kg/24 h IV | 15 mg/kg/24–48 h IV | 15 mg/kg/72 h IV |
| Teicoplanin * | 10–12 mg/Kg/24 h IV | 10–12 mg/kg/48 h IV | 10–12 mg/kg/72 h IV | 10–12 mg/kg/72 h IV |
| Gluco/lipo peptides | ||||
| Daptomycin | 8–12 mg/Kg/24 h IV | 8–12 mg/kg/24 h IV | 8–12 mg/kg/48 h IV | 8–12 mg/kg/48 h IV |
| Dalbabancin | 1500 mg/2 weeks IV | 1000–1500 mg/2 weeks IV | 1000 mg/2 weeks IV | 1000 mg/2 weeks IV |
| Oritavancin | 1200 mg/2 weeks IV | 1200 mg/2 weeks IV | 1200 mg/2 weeks IV | 1200 mg/2 weeks IV |
| Oxazolidines | ||||
| Linezolid | 600 mg/12 h IV/po | 600 mg/12 h IV/po | 600 mg/12 h IV/po | 600 mg/12 h IV/po |
| Tedizolid | 200 mg/24 h IV/po | 200 mg/24 h IV/po | 200 mg/24 h IV/po | 200 mg/24 h IV/po |
| Quinolones | ||||
| Ciprofloxacin | 400 mg/8 h IV 750 mg/12 h po |
400 mg/12 h IV 500 mg/12 h po |
200 mg/8–12 h IV 500 mg/12 h po |
400 mg/24 h IV 750 mg/24 h po |
| Levofloxacin | 500 mg/12 h IV/po | 500 mg/24 h IV/po | 250 mg/24 h IV/po | 250 mg/24–48 h IV/po |
| Moxifloxacin | 400 mg/24 h po | 400 mg/24 h po | 400 mg/24 h po | 400 mg/24 h po |
| Others | ||||
| Fosfomycin | 4 g/8 h IV | 4 g/12 h IV | 4 g/24 h IV | 2–4 g/24–48 h IV |
| Tigecycline | 50–100 mg/12 h IV | 50–100 mg/12 h IV | 50–100 mg/12 h IV | 50–100 mg/12 h IV |
| Rifampin | 600–1200 mg/24 h IV/po | 600–1200 mg/24 h IV/po | 600 mg/24 h IV/po | 600 mg/24 h IV/po |
*: Drug levels must be monitored. ¶: In patients on Haemodialysis (HD) doses IV must be administered after the HD session, excepting gentamycin that must be administered at the beginning, monitoring peak and valley levels.