Table 7.
Typical drug dosing for NTM disease.
| Drug | Standard dose | Renal adjustment |
|---|---|---|
| Amikacin | 15 mg/kg1 IV daily | Est crcl < 30 ml/min:12–15 mg/kg1 three times weekly |
| Azithromycin | 250 mg once daily | No adjustment |
| Bedaquiline Fumarate | Week 1–2: 400 mg once daily with food Week 3–24: 200 mg three times weekly with food |
No adjustment |
| Cefoxitin | 200 mg/kg/day IV in 3 divided doses2 (maximum 12 g/24 h) |
Est crcl 30–49 ml/min: 1–2 g q 8–12 h Est crcl 10–29 ml/min: 1–2 g q12-24 h Est crcl < 10 ml/min: 1–2 g q24-48 h |
| Ciprofloxacin | 500–750 mg twice daily |
Est crcl 10–49 ml/min: 250–500 mg twice daily Est crcl < 10 ml/min: 250–500 mg daily |
| Clarithromycin | 500 mg twice daily or 1000 mg once daily (extended release) |
Est crcl < 30 ml/min: 1) 500 mg once daily -OR- 2) 500 mg once, then 250 mg twice daily |
| Clofazimine | 100 mg daily | No adjustment |
| Delaminid | 100 mg twice daily |
Est crcl < 30 ml/min: Not recommended |
| Doxycycline | 100 mg twice daily | No adjustment |
| Ethambutol | 15–20 mg/kg (maximum 1600 mg) daily |
Est crcl < 30 ml/min: 20–25 mg/kg three times weekly |
| Ethionamide3 | 15–20 mg/kg/day (max 1000 mg) daily in divided doses | No adjustment |
| I/C | Imipenem 1000 mg/Cilastin 1000 mg given intravenously twice daily |
Est crcl 20–40 ml/min: 750 mg −750 mg (I/C) every 12 h. Est crcl < 20 ml/min: 500 mg −500 mg (I/C) every 12 h) |
| Isoniazid3 | 5 mg/kg (max 300 mg) daily | No dose adjustment |
| Levofloxacin | 750 mg daily |
Est crcl 20–49 ml/min: 500–750 mg every 48 h Est crcl < 20 ml/min: 250–500 mg every 48 h |
| Linezolid3 | 600 mg daily | No adjustment4 |
| Minocycline | 200 mg once, then 100 mg twice daily |
Est crcl < 10 ml/min: Standard dose -OR- 200 mg once, then 100 mg once daily |
| Moxifloxacin | 400 mg daily | No dose adjustment |
| Rifabutin | 5 mg/kg (max 300 mg) daily |
Est crcl < 30 ml/min: Consider standard dose4 |
| Rifampin | 10 mg/kg (max 600 mg) daily | No dose adjustment |
| Streptomycin | 15 mg/kg1 daily |
Est crcl < 30 ml/min: 12–15 mg/kg1 3 times weekly |
| SMX/TMP | SMX/TMP 800 mg/160 mg twice daily |
Est crcl 15–29 ml/min: SMX/TMP 800 mg/160 mg once daily |
| Tedizolid | 200 mg once daily | No adjustment |
| Tigecycline | 100 mg IV once, then 50 mg twice daily2 | No adjustment |
Abbreviations: Est crcl – Estimate creatinine clearance, I/C – Imipenem/ Cilastin, IV – intravenous, kg – Kilogram, mg – Milligram, SMX/TMP – Sulfamethoxazole/Trimethoprim.
1Use an adjusted body weight (IBW + 0.4(ABW − IBW) for empiric dosing in the setting of obesity and follow serum levels.
2Some providers use reduced dose or schedule to optimize long-term tolerability.
3Consider Vitamin B6 25–50 mg daily to decrease risk of toxicity.
4Renally-cleared metabolite accumulation can occur. Monitor closely for toxicity.
aRifabutin: May consider decreasing to 50% of standard dose and monitoring serum drug levels to avoid toxicity. Standard dosing appropriate for patients on dialysis.