Table 5.

Dose recommendations for some frequently used antimicrobials during CRRT (CVVH, 25 mL/kg/h)

Antimicrobial	Loading dose	Maintenance dose
Amikacin	30-35 mg/kg	TDM
Meropenem	2 g	2 g over 3 h tid
Piperacillin-tazobactam	4 g/0.5 g	16 g/2 g (CI)
Vancomycin	35 mg/kg over 4 h	30 mg/kg (TDM = 25–30 mg/L)
Teicoplanin	15 mg/kg bid	600 mg od
Linezolid		600 mg tid
Ciprofloxacin	800 mg	400 mg tid
Tigecyclin	150 mg	100 mg bid
Colistin	9 MIU	4.5 MIU tid
Voriconazole	8 mg/kg bid	6 mg/kg bid
Fluconazole		600 mg bid
Cefepime		2 g tid
Gentamycin		7 mg/kg od
Bactrim	1200 mg/240 mg (3 amp)	800 mg/160 mg (2 amp) tid
Clindamycin		900 mg qid

TDM = therapeutic drug monitoring; od = once daily; bid = twice daily; tid = three times daily; qid = four times daily; amp = ampules; CI = continuous infusion; MIU = million units. According to references No. 68–77 – Adapted and changed from reference No. 63.