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Table 1 Recommended dosing regimens of the most frequently used renally excreted antimicrobials according to renal function

From: Bench-to-bedside review: Appropriate antibiotic therapy in severe sepsis and septic shock – does the dose matter?

  Renal function
Antibiotic Increaseda Normal Moderately impaired Severely impaired
Piperacillin/tazobatam 16/2 g q24 h CI [56, 57] or 3.375 q6 h EI over 4 hours [51] 4/0.5 g q6 h 3/0.375 g q6 h 2/0.25 g q6 h
Cefotaxime 4 to 6 g q24 h CI [14] or 2 g q4–6 h 2 g q6–8 h 2 g q6–8 h 1 g q6–8 h
Ceftazidime 4 to 6 g q24 h CI [55, 70] 2 g q8 h 1 g q8–12 h 0.5 to 1 g q24 h
Cefepime 4 to 6 g q24 h CI [71] or 2 g q8 h EI over 3 hours [72] 2 g q8 h 2 g q12 h 1 g q24 h
Imipenem 500 mg q4 h [46] or 250 mg q3 h over 3 hours CI [73] 500 mg q6 h 250 mg q6 h 250 mg q12 h
Meropenem 1 g q6 h over 6 hours CI [54] 500 mg q6 h 250 mg q6 h 250 mg q12 h
Ertapenem ND 1 g q24 h 1 g q24 h 500 mg q24 h
Gentamycin 9 to 10 mg/kg q24 hb [74] 7 mg/kg q24 hb [74, 75] 7 mg/kg q36–48 hb 7 mg/kg q48–96 hb
Tobramycin 9 to 10 mg/kg q24 hb [74] 7 mg/kg q24 hb [74, 75] 7 mg/kg q36–48 hb 7 mg/kg q48–96 hb
Amikacin 20 mg/kg q24 hb [8, 76] 15 mg/kg q24 hb 15 mg/kg q36–48 hb 15 mg/kg q48–96 hb
Ciprofloxacin 600 mg q12 h or 400 mg q8 h [7779] 400 mg q12 h 400 mg q12 h 400 mg q24 h
Levofloxacin 500 mg q12 h [80] 750 mg q24 h [37] 500 mg q24 h 500 mg q48 h
Vancomycin 30 mg/kg q24 h CIb [58, 61] 500 mg q6 hb 500 mg q12 hb 500 mg q24–72 hb
Teicoplanin LD 12 mg/kg q12 h for 3 to 4 doses; MD 6 mg/kg q12 h [81, 82]b LD 12 mg/kg q12 h for 3 to 4 doses; MD 4 to 6 mg/kg q12 h [81, 83]b LD 12 mg/kg q12 h for 3 to 4 doses; MD 2 to 4 mg/kg q12 h [81, 83]b LD 12 mg/kg q12 h for 3 to 4 doses; MD 2 to 4 mg/kg q24 h [81, 83]b
Daptomycin ND 6 mg/kg q24 h 6 mg/kg q24 h 6 mg/kg q48 h
  1. Data derived from Clinical Pharmacology, Gold Standard Multimedia [84] unless otherwise specified. aSuggested on the basis of some clinical and/or population pharmacokinetic studies. bGuided by therapeutic drug monitoring. CI, continuous infusion; EI, extended infusion; LD, loading dose; MD, maintenance dose; ND, not defined; q × h, every × hours.