Table 3.
Usual dosing of commonly used antibiotics in septic shock
| Antibiotics | Usual intravenous dose | Infusiona | Dose adjustment in renal dysfunction (CrClb in mL/min is given in parenthesis) |
|---|---|---|---|
| Piperacillin-tazobactam | 4.5 g QID | 4 h | 4.5 g TDS (20-40), 4.5 g BD (<20 or HD) |
| Meropenem | 1 g TDS | 3 h | 1 g BD (25-50), 500 mg BD (10-25), 500 mg OD (<10 or HD) |
| Imipenem (-cilastatin) | 1 g TDS | 3 h | 500 mg TDS (30-60), 500 mg BD (15-30), 250 mg BD (5-15 or <5c and undergoing HD) |
| Cefoperazone (-sulbactam) | 2 g BD | 3 h | 1 g BD (15-30), 500 mg BD (<15) |
| Cefepime | 2 g TDS | 3 h | 2 g BD (30-60), 1 g BD (10-30), 1 g OD (<10 or HD) |
| Ceftazidime | 2 g TDS | 3 h | 2 g BD (30-50), 1 g BD (15-30), 1 g OD (<15 or HD) |
| Amikacin | 15-30 mg/kg OD | 30 min | Administer usual dose every 36 h (40-60), every 48 h (20-40), single dosed with monitoring levels (<20) |
| Tobramycin | 5-7 mg/kg OD | 30 min | Administer usual dose every 36 h (40-60), every 48 h (20-40), single dosed with monitoring levels (<20) |
| Gentamicin | 5-7 mg/kg OD | 30 min | Administer usual dose every 36 h (40-60), every 48 h (20-40), single dosed with monitoring levels (<20) |
| Levofloxacin | 750 mg OD | 1 h | 750 mg every 48 h (20-50), 750 mg loading followed by 500 mg every 48 h (<20 or HD) |
| Ciprofloxacin | 400 mg TDS | 1 h | 400 mg BD (10-30), 400 mg OD (<10 or HD) |
| Vancomycin | 20-30 mg/kg loading, 15-20 mg/kg BD maintenance | 4 h | Maintenance dose OD (15-50), every 72 h (<15 or HD) |
| Teicoplanin | 12 mg/kg loading, 6 mg/kg OD maintenance | 4 h | Maintenance dose 3 mg/kg OD (40-60), 2 mg/kg OD (<40 or HD) |
| Linezolid | 600 mg BD | 30 min | No dose adjustment required |
| Colistin (CBA 1 mg=CMS 30,000 U) | CBA 5 mg/kg loading, 2.5 mg/kg BD maintenance | 2 h | Maintenance dose 1.5-2.0 mg/kg BD (30-50), 1.25-1.5 mg/kg BD (10-30), 1 mg/kg BD (<10), for HD-1.5 mg/kg BD on dialysis days and 1 mg/kg BD on other days |
| Polymyxin B | 20,000-25,000 U/kg loading, 125,000-15,000 U/kg BD maintenance | 2 h | No dose adjustment required |
| Tigecycline | 100 mg loading, 50 mg BD | 30 min | No dose adjustment required |
| Minocycline | 200 mg loading, 100 mg BD | 30 min | No dose adjustment required |
aExtended infusion method. First dose may be given over 30 min to rapidly achieve therapeutic drug levels, bCrCl (in ml/min) may be estimated using Cockcroft-Gault formula=([140-age in years] × weight in kg)/(72 x serum creatinine in mg/dl) (for women, multiply by 0.85), cDo not administer in patients with CrCl ≤5 unless HD is started within 48 h, dSubsequent doses based on the serum levels. CBA: Colistin base activity, CMS: Colistimethate sodium, CrCl: Creatinine clearance, HD: Hemodialysis (intermittent, thrice weekly), BD: every 12 h, OD: every 24 h, TDS: every 8 h, QID: every 6 h