Dosage, by Type of Renal Replacement Therapy

Drug CVVH CVVHD or CVVHDF

Acyclovir 5-10 mg/kg q24h 5-10mg/kg q12-24h
Amikacin
Load: 10 mg/kg
Maintenance: 7.5 mg/kg q24-48h
Load: 10 mg/kg
Maintenance: 7.5 mg/kg q24-48h
Amphotericin B
Deoxychelate 0.5-1 mg/kg q24h 0.5-1 mg/kg q24h
Lipid complex 3-5 mg/kg q24h 3-5 mg/kg q24h
Liposomal 3-5 mg/kg q24h 3-5 mg/kg q24h
Ampicillin Load 2gm IV then 1-2 g q8-12h Load 2gm IV then 1-2 g q6-8h
Ampicillin-
sulbactam Load 3 gm IV then 1.5-3 g q8-12h Load 3gm IV then 1.5-3 g q6-8h
Aztreonam Load 2 gm IV then 1-2 g q12h Load 2gm IV then 1 gm q8h or 2 g q12h
Cefazolin Load 2gm IV then 1-2 g q12h Load 2 gm IV then 1gm q8h or 2g q12h
Cefepime Load 2 gm IV then 1-2 g q12h Load 2gm IV then 1gm q8h or 2 g q12h
Cefotaxime 1-2 g q8-12h 1-2 g q6-8h or 2gm q12h
Ceftazidime Load 2gm IV then 1-2 g q12h Load 2gm IV then 1gm q8h or 2 g q12h
Cefuroxime 1.5 g q 8-12h 1.5 g q8h
Ciprofloxacin 200-400 mg q12-24h 400mg q12h
Colistimethate 2.5 mg/kg q48h
2.5 mg/kg IV q48h (can increase to q24h in
patients with deep seated infections and dialysis
flowrates >1 L/hr)
Daptomycin 4 or 6 mg/kg q48h 4 or 6 mg/kg q48h
Fluconazole Load 400-800mg then 200-400 mg q24h Load 400-800 mg then 400-800 mg q24h























CRRT Dosing Information
Dosage, by Type of Renal Replacement Therapy
Drug CVVH CVVHD or CVVHDF
Ganciclovir
Induction: 2.5mg/kg q24h
Maintenance: 1.25mg/kg q24h
Induction: 2.5mg/kg q12h
Maintenance: 2.5mg/kg q24h
Gentamicin
Load: 3 mg/kg
Maintenance: 2 mg/kg q24-48h
Load: 3 mg/kg
Maintenance: 2 mg/kg q24-48h
Gentamicin
gram-positive synergy 1 mg/kg q24-36h 1 mg/kg q24-36h
Imipenem-cilastin Load 1 gm IV then 500 mg q8h Load 1 gm IV then 500 mg q6h
Levofloxacin* Load 500-750mg then 250mg q24h Load 500-750mg, then 250-750 mg q24h
Meropenem

Load 1 gm IV then 500-1000mg q12h Load 1 gm then 500-1000mg q8-12h
Nafcillin 2 g q4-6h 2 g q4-6h
Penicillin Load 4 MU then 2 MU q4-6h Load 4 MU then 2-4 MU q4-6h
Piperacillin 3-4 g q 8-12h 3-4 g q6-8h
Piperacillin-tazobactam* 2.25 -3.375g q6-8h 3.375gm q6h
Ticarcillin-clavulanate Load 3.1 gm then 2gm q6-8h Load 3.1gm then 3.1 gm q6h
Trimethoprim-
sulfamethoxazole 2.5-7.5mg/kg (TMP) q12h 2.5-7.5mg/kg (TMP) q12h
Tobramycin
Load: 3 mg/kg
Maintenance: 2 mg/kg q24-48h
Load: 3 mg/kg
Maintenance: 2 mg/kg q24-48h
Vancomycin
Load: 15-25 mg/kg
Maintenance: 10-15 mg/kg q24-48h
Load: 15-25 mg/kg
Maintenance: 15 mg/kg q24h
Voriconazole
Load: 400mg PO q12h x 2
Maintenance: 200mg PO q12h
Load: 400mg PO q12h x 2
Maintenance: 200mg PO q12h
*Use higher dose listed for pseudomonal coverage in skin infections or pneumonia.
If MIC of organism is >4mcg/mL, may need to increase dose.
For additional information, see dosing recommendations in Drug Prescribing in Renal Failure. Fifth Edition.
CRRT Dosing Information