TABLE 5.
Recommended intravenous antibiotic dosing and administration schedules for critically ill adult patients (with normal renal function).†
| Agent | Dosing and administration schedules |
|---|---|
| Aminoglycosides ‡ | |
| Amikacin | 15 mg/kg – 30 mg/kg once daily |
| Gentamicin | 7 mg/kg once daily |
| Tobramycin | 7 mg/kg once daily |
| ΒLICs | |
| Ceftazidime-avibactam | 2.5 g 8-hourly, infused over 2 h |
| Ceftolozane-tazobactam | 3 g 8-hourly, infused over 1 h |
| Piperacillin-tazobactam | 4.5 g loading§, 4.5 g 6-hourly infused over 3 h or 18 g infused over 24 h |
| Carbapenems | |
| Ertapenem | 1 g once-daily or 12-hourly, infused over 1 h |
| Doripenem¶ | 1 g 8-hourly, infused over 4 h |
| Imipenem | 1 g 6–8 hourly, infused over 1–3 h |
| Meropenem | 2 g 8–hourly, infused over 3 h |
| Cephalosporins | |
| Cefepime | 2 g loading§, 2 g 8-hourly infused over 4 h or 6 g infused over 24 h |
| Ceftazidime | 2 g loading§, 2 g 8-hourly infused over 4 h or 6 g infused over 24 h |
| Fluoroquinolones | |
| Ciprofloxacin | 400 mg 8-hourly |
| Levofloxacin | 750 mg once daily |
| Polymyxins | |
| Colistin†† | 9 MU – 12 MU loading, 3 MU 8-hourly or 4.5 MU 12-hourly (60 kg) |
| Polymyxin B‡‡ | 20 000 IU/kg – 25 000 IU/kg (2 mg/kg – 2.5 mg/kg) loading dose and 12 500 IU/kg – 15 000 IU/kg (1.25 mg/kg – 1.5 mg/kg) 12-hourly |
| Tigecycline | 200 mg loading§, 100 mg 12-hourly |
BLICs: β-lactam β-lactamase inhibitor combinations.
, Maximum dosing to account for pharmacokinetic disturbances in this population and to target the upper end of clinical breakpoints.
, Subsequent doses and dosing interval should be based on pharmacokinetic evaluation and use of therapeutic drug monitoring.
Typically, maintenance doses are begun 30 min – 1 h following administration of the loading dose.
, Doripenem at standard doses has no advantage over group 2 carbapenems for susceptible Gram-negatives.
, For renal impairment, continuous renal replacement therapy and haemodialysis refer to the consensus colistin guideline, South Africa.18
, Polymyxin B, unlike colistin, is administered in its active state and not as a prodrug. Hence it has superior pharmacological properties with less pharmacokinetic variability and dosing that is independent of renal function.