Stanford Hospital & Clinics Antimicrobial Dosing Reference Guide 2014

This document is also located on the SHC Intranet (http://portal.stanfordmed.org/depts/pharmacy)

and http://bugsanddrugs.stanford.edu ABX Subcommittee Approved: January 30, 2014
Formulas for dosing weights: Ideal body weight IBW (male) = 50kg + (2.3 x height in inches > 60 inches) ∙
Ideal body weight IBW (female) = 45kg + (2.3 x height in inches > 60 inches) ∙ Adjusted Body Weight ABW (kg) = IBW + 0.4 (TBW – IBW)
Intermittent
Drug CrCl >50 mL/min CrCl 10–50 mL/min CrCl <10 mL/min CRRT
Hemodialysis (IHD)
HSV: 2.5 mg/kg q24h CVVH: 5-10mg/kg q24h
Acyclovir (IV)1,4,5, 6,7,8 HSV: 5 mg/kg q8h Same dose HSV: 2.5 mg q24h
HSV encephalitis/zoster: CVVHD/F: 5-10mg/kg q12h
(Use ideal BW for HSV encephalitis/zoster: CrCl 25–50: q12h HSV encephalitis/zoster:
5 mg/kg q24h (meningoencephalitis/VZV:
obese) 10 mg/kg q8h CrCl 10–25: q24h 5 mg/kg q24h
Dose daily, but after HD on HD days 10mg/kg q12h)

CrCl > 25 CrCl 10–25 CrCl <10

Acyclovir (PO)1,5 HSV mucocutaneous 400 mg q8h 200 mg q8h 200 mg q12h See CrCl < 10 mL/min No Data
VZV 800 mg q4h (or 5x daily) 800 mg q8h 800 mg q12h

Amphotericin B
3 – 6 mg/kg/day No change No change No change No change
Liposomal1
CrCl >60 CrCl 40–60: CrCl 20–40 CrCl < 20
Conventional 5 – 7.5 mg/kg 5 – 7.5 mg/kg 5 – 7.5 mg/kg
Amikacin1,2,3,7 dosing q8h q12h q24h
(Use ideal BW; use 5 mg/kg
CrCl > 30: 10 mg/kg load,
adjusted BW in High-dose load, then 5 – 7.5 mg/kg post HD only
morbidly obese) 15 – 20 mg/kg 15 mg/kg 15 mg/kg q48h then 7.5 mg/kg q24–48h
extended- by level
q24h q36h CrCl < 30:
interval dosing consult pharmacist
Not recommended consult pharmacist
See appendix for
th
complete guidelines Timing of levels: Draw trough 30 min prior to 4 dose. Draw peak 30 min after infusion ends
Once daily dosing: goal peak 35–60; goal trough <4. Consult Hartford Nomogram
Conventional dosing: goal peak 25–35 for serious infections; 15–20 for UTI goal trough:<5-8
Usual dose: 250 – 500 mg q8h
(Alt: 875 mg q12h; CrCl 10–30:
Amoxicillin (PO) 250 – 500 mg q24h 250 – 500 mg q24h No Data
H pylori: 1,000 mg q12h; 250 – 500 mg q12h
Procedural ppx: 2,000 mg x 1)
CrCl <30: Do not use
Usual dose: 250 – 500 mg q8h
Amoxicillin/clavulanate 875mg tablet or ER tab
or 875 mg q12h; 250 – 500 mg q24h 250 – 500 mg q24h No Data
(PO) CrCl 10-30: 250 – 500 mg
CAP: 2,000mg ER q12h
q12h
CVVH: 1 – 2 g q8–12H
1 – 2 g q4–6h 1 – 2 g q6–12h 1 – 2 g q12–24h 1 – 2 g q12–24h
CVVHDF: 2g load, then
1,3,4,6
Ampicillin (IV) 1–2g q6–8h
Meningitis/endocarditis: Meningitis/endocarditis: Meningitis/endocarditis: Meningitis/endocarditis:
Meningitis/endocarditis:
2 g q4h 2 g q6–12h 2 g q12–24h 2 g q12–24h
2 g q6h
Ampicillin/sulbactam1,2,4, 1.5 g – 3 g q12–24h 3 g load,
6,7 1.5 g – 3 g q6h CrCl <30: 1.5 g – 3 g q12h CrCl <15: 1.5 g – 3 g q24h
Dose daily, but after HD on HD days then 1.5 – 3 g q6–8h
Azithromycin (IV/PO)1 500 mg q24h No change No change No change No change
Aztreonam1,2, 6 1–2g LD, then 500mg q12h 1 g q8h
1 – 2 g q8h CrCl <30: 1 g q8h 500 mg q8h
Severe: pseudomonas, Severe: 1 – 2 g LD, then 500 - or –
Severe: 2 g q6–8h Severe: 1 g q6–8h Severe: 500 mg q6–8h
life-threatening infections mg q8h 2 g q12h
70 mg x 1, then 50 mg q24h
Caspofungin1
Consider 70 mg x 1, then 35 mg q24h if severe hepatic dysfunction (Child–Pugh score >7); No change No change
(Hepatic adjustment)
70 mg q24h if on phenytoin, rifampin, other strong enzyme inducers
CrCl ≥ 35: CrCl 10 – 34: 1 g q24h
Cefazolin1,2, 5, 6,7, 8 Mild/moderate: 1 g q8h Mild/moderate: 0.5 g q12h 1 g q24h Dose daily, but after HD on HD days 2 g q12h
Severe: 2 g q8h Severe: 1 g q12h alt: 2g post-HD only
CrCl >60 CrCl 30 –60: CrCl < 30 General:
1 g q8h or 1 g q12h or 0.5 g q24h 0.5 – 1 g q24h 2g load, then 1 g q8h
Cefepime 1,4, 5, 6, 7 General
2 g q12h 2 g q24h
1 g q24h Alt: 1 – 2 g post-HD only – or –
1 g q12h or CNS/FN: 2 g q12h
CNS/FN 2 g q8h 2 g q12h Dose daily, but after HD on HD days
2 g q24h 1 g q24h

Usual dose: 1 – 2 g q8h 0.5 – 1 g q24h 2g load, then 1 g q8h

CrCl 30-50: 1 – 2g q12h Alt: 1 – 2 g q48-72h
Ceftazidime1,6 (IV) 1 – 2 g q48-72h – or –
CrCl 10-30: 1 – 2g q24h
Severe: 2g q8h 2 g q12h
Dose daily, but after HD on HD days
Ceftaroline1 CrCl 30-50: 400 mg q12h 200 mg q12h
600 mg q12h CrCl <15: 200 mg q12h No Data
(SHC Restriction) CrCl 15-30: 300 mg q12h Dose daily, but after HD on HD days

1 – 2 g q24h
Ceftriaxone (IV)1, 5, 9 Endocarditis, osteomyelitis: 2 g q24h No change No Change No Change
Dose daily, but after HD on HD days
Meningitis, E. faecalis endocarditis: 2 g q12h

CrCl >50 CrCl 30 – 50 CrCl < 30

400 mg IV q12h 400 mg IV q24h
Ciprofloxacin (IV/PO)1,2, General infections Same 200 – 400 mg IV q24h 400 mg IV q12–24h
5, 6, 8 500 mg PO q12h 500 mg PO q24h
250 – 500 mg PO q24h 500 mg PO q12–24h
Pseudomonas, 400 mg IV q8h 400 mg IV q8–12h 400 mg IV q24h Dose daily, but after HD on HD days
severe 750 mg PO q12h 500 mg PO q12h 500 mg PO q24h

600 – 900 mg IV q8h

Clindamycin1,2 No change No change No change No change
150 – 450 mg PO q6h
1,5,6
Colistin (IV) CrCL >80:
CrCL 30-49:
(SHC Restriction) 1.25 – 2.5 mg/kg q12h
2.5mg/kg q24h
(Dosage expressed in 1.5mg/kg q24h 1.5 mg/kg q24h 2.5 mg/kg q12–24h
terms of colistin base; CrCL 50-79:
CrCL <30: 1.5mg/kg q24h
Use ideal BW in obese) 1.25 – 1.9 mg/kg q12h
4 – 8 mg/kg q48h
Skin/Soft tissue:
Daptomycin1, 10, 11, 21 Same dose q48h Alt: 8 mg/kg q48h or 4 – 6
4 – 6 mg/kg q24h
(SHC Restriction) CrCl < 30: Dose q48h, but after HD on HD days mg/kg q24h depending on
Endocarditis/Bacteremia: Same dose q48h
(Use adjusted BW in Same dose q48h site/severity of infection, or if
6 – 8 mg/kg q24h alt: ≥6 mg/kg post-HD only
obese) not responding to standard
VRE: Recommend ID consult
dosing
1
Doxycycline (IV/PO) 100 mg q12h No change No change No change No change
 Intermittent
Drug CrCl >50 mL/min CrCl 10–50 mL/min CrCl <10 mL/min CRRT
Hemodialysis (IHD)
Ertapenem (IV/IM) 1 500 mg q24h
1 g q24h CrCl <30: 500 mg q24h 500 mg q24h Dose daily, but after HD on HD days
1 g q24h

Dose by ideal body weight:

40 – 55 kg: 800 mg q24h
Ethambutol (PO)1,7
56 – 75 kg: 1200 mg q24h Same dose q24-36h Same dose q48h Same dose post HD only Same dose q24-36h
(Use ideal body weight)
76 – 90 kg: 1600 mg q24h
(max dose: 1600 mg/day)
Fidaxomicin (PO)
(SHC Restriction) 200 mg q12h x 10 days No change No change No change No change

Fluconazole (IV/PO)1,5,6, 8 200 – 400 mg q24h

Dose by indication. Load (50% of normal dose) (25% of normal dose) Dose by indication:
Severe/CNS infections: 400 – 800 mg q24h
800 mg for candidemia q24h q24h 200 – 800 mg post HD only
up to 800 mg q24h

CrCl(mL/min/kg) CMV induction CMV maintenance HSV

> 1.4 60 mg/kg q8h 90 mg/kg q12h 90 mg/kg q24h 120 mg/kg q24h 40 mg/kg q12h 40 mg/kg q8h
> 1.0 – 1.4 45 mg/kg q8h 70 mg/kg q12h 70 mg/kg q24h 90 mg/kg q24h 30 mg/kg q12h 30 mg/kg q8h
> 0.8 – 1.0 50 mg/kg q12h 50 mg/kg q12h 50 mg/kg q24h 65 mg/kg q24h 20 mg/kg q12h 35 mg/kg q12h
Foscarnet1, 5 > 0.6 – 0.8 40 mg/kg q12h 80 mg/kg q24h 80 mg/kg q48h 105 mg/kg q48h 35 mg/kg q24h 25 mg/kg q12h
> 0.5 – 0.6 60 mg/kg q24h 60 mg/kg q24h 60 mg/kg q48h 80 mg/kg q48h 25 mg/kg q24h 40 mg/kg q24h
≥ 0.4 – 0.5 50 mg/kg q24h 50 mg/kg q24h 50 mg/kg q48h 65 mg/kg q48h 20 mg/kg q24h 35 mg/kg q24h
< 0.4 Not recommended Not recommended Not recommended Not recommended Not recommended Not recommended
60 – 90 mg/kg loading dose (post-HD),
IHD No data No data No data No data
then 45 – 60 mg/kg/dose post-HD only
CRRT No data – Dose as for CrCL 10 – 50 mL/min

CMV CrCl >70* CrCl >50 CrCl >25 CrCl >10 CrCl <10
5 mg/kg 2.5 mg/kg 2.5 mg/kg 1.25 mg/kg 1.25 mg/kg
Induction (I)
q12h q12h q24h q24h 3x/wk I: 1.25 mg/kg post HD only I: 2.5 mg/kg q12–24h
Ganciclovir1, 6(IV)
Maintenance 5 mg/kg 2.5 mg/kg 1.25 mg/kg 0.625 mg/kg 0.625 mg/kg M: 0.625 mg/kg post HD only M: 1.25 – 2.5 mg/kg q24h
(M) q24h q24h q24h q24h 3x/wk
*Manufacturer’s CrCl cutoffs. Please refer to BMT protocols if applicable

CrCl >60 CrCl 40–59 CrCl 20–39 CrCl <20 HD CRRT

1.7 mg/kg q24h
1.7 mg/kg q8h 1.7 mg/kg q12h or
or or CrCl > 30: 2 mg/kg 2 mg/kg loading
1.5–2.5 mg/kg
Gram negative 4 – 7 mg/kg q24h 4 – 7 mg/kg q36h 4 – 7 mg/kg q48h loading dose, dose, then 1.5
q24–48h
(high-dose (high-dose CrCl < 30: then per level mg/kg post HD
extended-interval*) extended-interval*) Not recommended
(high-dose extended-interval*)
Gentamicin6 1 mg/kg q48-72h;
Gram positive 1 mg/kg load, 1mg/kg q24h,
1 mg/kg q8h** 1 mg/kg q12h 1 mg/kg q24h consider redosing
See appendix for synergy then by level then per level
when level <1 mg/L
complete guidelines Goal levels: (Gram-negative infections): Goal peak for traditional dosing (4–8mg/L), trough (<1-2mg/L) for treatment.
(Gram-positive synergy): Goal peak 3–5mg/L (3-4 if using IDSA endocarditis guidelines). Goal trough <1 mg/L
Timing of levels: Draw trough 30 min prior to 4th dose. Draw peak 30 minutes after infusion ends (4 th dose). (For CrCL <20, may check levels sooner than 4th
dose)
For once-daily dosing, draw a single random level 8 to 12 hours after dose given adjustments are made based on a published Hartford
nomogram.
For HD, draw trough pre-HD, and peak 30 min after end of each infusion
** Streptococci, Streptococcus bovis, Strep. viridans endocarditis: optional dosing 3mg/kg q24h for CrCl > 60
** Staphylococci endocarditis: optional dosing 3mg/kg in 2 or 3 equally divided doses

500 mg q6h
500 mg q8h
Imipenem/Cilastatin1,2, 6
500 mg q8h 250 – 500 mg q12h 250 – 500 mg q12h
(Non-formulary) Severe & moderately
Severe: 500 mg q6h
susceptible: 1g q6-8h
max: 50 mg/kg/day or 4g/day

Isoniazid1 No change
300 mg q24h No change No change No change
(Dose after HD on HD days)

CrCl ≥50 CrCl 20–49: CrCl < 20

500 mg x1, See CrCl < 20 ml/min
Levofloxacin (IV/PO)1,2, 5, General 250 – 500 mg q24h 250 – 500 mg q48h 750 mg load,
6, 8 then 250 mg q48h
(Dose after HD on HD days)
then 250 – 750 mg q24h
Pseudomonas 750 mg x1,
750 mg q24h 750 mg q48h
/CAP: then 500 mg q48h
1,4
Linezolid (IV/PO) No change.
600 mg q12h No change No change No change
(SHC Restriction) (Dose after HD on HD days)
Meropenem1,2, 6, 8, 18 CrCl >50 CrCl 26–50: CrCl 10–25 CrCl <10
500 mg q24h 1 g q8–12h
(SHC Restriction) Usual dose 1 g q8h 1 g q12h
(Dose after HD on HD days) - or -
Consider 3-hr extended (FN, Pneumonia, or or 0.5 g q8–12h 0.5 g q12–24h
500 mg q6–8h
infusion to optimize Pseudomonas) 500mg q6h 500mg q6h
CF/CNS: 1 g q24h
fTime/MIC for q8h 1 g q12h (Dose after HD on HD days)
CF/Meningitis 2 g q8h 2 g q12h 0.5 g q12–24h CF/CNS: 2g q12h
regimens or 0.5 g q8h
1 No change
Metronidazole (IV/PO) 500 mg q6 – 8h 500 mg q8h 500 mg q6–8h
Severe hepatic impairment: can consider 500 mg q12h
Moxifloxacin (IV/PO)1 400 mg IV/PO q24h No change No change No change No change

2 g q4h
Nafcillin1 No change No change No change No change
Mild infections: 1gm q4h

Prophylaxis Treatment Treatment (severe/ICU) Treatment/prophylaxis:

Prophylaxis: 75 mg q24h
30 mg after every other session
Oseltamivir (PO)1,2, 15,16,17 CrCl ≥ 30 75 mg q24h 75 mg q12h 150 mg q12h Treatment: 75 mg BID
Severe/ICU:
CrCl < 30 75 mg q48h 75 mg q24h 150 mg q24h Severe/ICU: 150 mg BID
60 mg after every other session
Mild: 0.5-1 mu q4-6h, or 1-2 mu
4mu x1, then 2 – 4 mu q4–
Penicillin G (IV)1, 5, 6 2 – 4 mu q4h 2 – 3mu q4h 1 – 2mu q6h q8-12h
6h
Severe: 2 mu q4-6h
 Intermittent
Drug CrCl >50 mL/min CrCl 10–50 mL/min CrCl <10 mL/min CRRT
Hemodialysis (IHD)
CrCl >40 CrCl 20–40 CrCl <20: General: 2.25 g q12h 3.375 g q6h
General 3.375 g q6h 2.25 g q6h 2.25 g q8h
Piperacillin/tazobactam
1,2,4, 5, 6, 8, 22 Pseudomonas/ 4.5 g q6h 3.375 g q6h 2.25 g q6h Pseudomonas/PNA/ severe Extended infusion
nosocomial PNA/ Extended infusion for CrCl > 20: infections: 3.375 – 4.5 g q8h
3.375 g q12h over 4h 2.25 g q8h (infused over 4 h)
severe: 3.375 – 4.5 g q8h over 4h
Solution Tablet
Prophylaxis 200 mg TID 300mg BID x 1day, then 300mg QD
No renal adjustment. Posaconazole levels shown to have great
Posaconazole (PO)1,2, 22 Oropharyngeal candiasis: 100mg Not FDA approved for treatment; degree of interpatient variability. Many clinicians would
(SHC Restriction) BID x 1 day; then 100mg daily limited data on optimal treatment recommend blood levels to assess efficacy. Consider drawing a
Treatment Refractory oropharyngeal dose – Recommend ID consult trough 4 - 7 days after initiating dose
candidiasis: No dose established- ongoing
200mg QID or 400mg BID clinical trials evaluating 300mg daily.
Dose by ideal body weight:
40 – 55 kg: 1000 mg
Pyrazinamide (PO)1, 5, 12 CrCl < 30: Same dose administer
56 – 75 kg: 1500 mg No data
(Use ideal BW) Same dose 3 times per week after HD only
76 – 90 kg: 2000 mg
(max 2000 mg/day)
TB: 10 mg/kg q24h (max: 600 mg)
Rifampin (IV/PO)1, 13, 14
Endocarditis: 300 mg q8h No change No change No change No change
Capsule size: 150mg, 300mg
PJI: 300-450 mg q12h
Tobramycin20 Refer to Gentamicin for dosing. See appendix for complete guidelines.
2.5 – 5 mg/kg TMP q24h*
Trimethoprim (TMP)/ 5 – 10 mg/kg/day TMP
Sulfamethoxazole 5 – 10 mg/kg/day TMP divided
CrCl < 30: 2.5 – 5 mg/kg/day TMP divided q8 – 12h PCP/ Stenotrophomonas: divided q12h
(IV/PO)1, 5, 6 q6–8h
7.5 – 10 mg/kg TMP q24h*
(Dose by ideal or PCP/Stenotrophomonas:
PCP/Stenotrophomonas: 7.5 – 10 mg/kg/day TMP divided *(Dose after HD on HD days) PCP/ Stenotrophomonas:
adjusted BW in obese) 15 – 20 mg/kg/day TMP
q8–12h 10 – 15mg/kg/day TMP
SS = 80 mg TMP = 10 ml po soln divided q6-8h
DS =160 mg TMP = 20ml po soln Alt: 5-20 mg/kg TMP post-HD divided q12h
only
Treatment CrCl >30: CrCl 10-30: <10
CrCl >50: 1 g q8h 1 g q24h 500 mg q24h
VZV
CrCl 30-50: 1g q12h
Initial episode: 1 g q12h Initial episode: 1 g q24h Initial episode:
Valacyclovir (PO)1 500 mg q24h
Recurrent episode: Recurrent: 500mg q24h
Genital 500 mg q24h
Please refer to 500mg q12h No Data
herpes (Dose after HD on HD days)
transplant protocols if Suppressive:
applicable Suppressive Therapy: 500mg q24-48h
1000 mg q24h
CrCl >50: 500 mg q12h x 2 doses 500 mg x 1
2 g q12h x 2 doses dose
Herpes
labialis
CrCl 30-50:
1g q12h x 2 doses

Valganciclovir (PO)1 CrCl > 60 CrCl 40 – 59 CrCl 25 – 39: CrCl 10 – 24 CrCl < 10, IHD, CRRT
Please refer to
transplant protocols if Induction (14-21 days) 900 mg q12h 450 mg q12h 450 mg q24h 450 mg q48h
applicable Not recommended, use ganciclovir
Maintenance/ prophylaxis 900 mg q24h 450 mg q24h 450 mg q48h 450 mg twice/week

Consider loading dose of 25–30 mg/kg (max 2 g) for severe infections and ICU
CrCl >50 CrCl 30–49 CrCl 15–29 CrCl <15
15 – 20 mg/kg 15 – 20 mg/kg 10 – 15 mg/kg 10 – 15 mg/kg 15 – 25mg/kg LD, then
Vancomycin (IV)6, 19, 21 20 mg/kg LD,
q8–12h q24h q24h q24–48h 10 – 15mg/kg q24h
(Use actual body then redose with
Goal trough 10–15 mcg/ml (cellulitis, skin/soft tissue infections) 10 – 15mg/kg post dialysis
weight) Goal trough 15–20 mcg/ml (pneumonia, bacteremia, endocarditis, osteomyelitis) Draw level prior to 3rddose.
when level <15 – 20
Timing of levels: Draw trough< 30 minutes before 4th dose of new regimen. When SCr Adjust to levels
acutely rises, hold dose, restart when level <15 - 20
See appendix for complete guidelines
Poor systemic absorption- used for the treatment of Clostridium difficile-associated diarrhea
Vancomycin PO1
General: 125 – 250 mg QID No change No change
Oral solution formulary
Severe/complicated: 500 mg QID
Voriconazole
6 mg/kg IV q12h x 2, IVPO conversion 1:1 (round to nearest tablet size- available in 200 mg and 50 mg tablets)
(IV/PO)1,22,23
then 4 mg/kg IV q12h
(SHC Restriction)
Caution with IV: accumulation of IV vehicle cyclodextran occurs. Consider PO unless benefits justify risks of IV use.
(Dose by adjusted BW
400 mg PO q12h x 2, Levels shown to have great degree of interpatient variability. Many clinicians would recommend blood levels to assess efficacy.
in obese)
then 200 mg PO q12h Consider drawing a trough 4 - 7 days after new dose
Abbreviations: SCr = serum creatinine; LD = loading dose; MU= million units; PNA = pneumonia; HD = hemodialysis; CAP = community acquired pneumonia; CRRT = continuous renal
replacement therapy; TMP = trimethoprim; PCP: pneumocystis jiroveci pneumonia; TB = tuberculosis; UF = ultrafiltration
CRRT dosing: doses listed are for CVVHDF and CVVHD modalities, which are the most common modes at SHC. Note that these are generally higher than doses used in CVVH.
References:
1. Lexi–Drug, Lexi–Comp® [Internet database]. Hudson, OH: Lexi–Comp, Inc. Available at http://www.crlonline.com. Accessed March, 2011
2. The Sanford Guide to Antimicrobial Therapy, 39th ed. Sperryville, VA: Antimicrobial Therapy. 2009
3. Drug Prescribing in Renal Failure, 5th ed. Philadelphia, PA: Dosing Guidelines for Adults and Children, 2007
4. McEvoy G (Ed). American Hospital Formulary Service Drug Information. Bethesda, MD: American Society of Health–System Pharmacists; 2008
5. Micromedex® Healthcare Series [Internet database]. Greenwood Village, CO: Thomson Reuters (Healthcare), Inc. Available at http://www.thomsonhc.com/hcs/librarian. Accessed March, 2011
6. Heinz et al., Antimicrobial Dosing Concepts and Recommendations forCritically Ill Adult Patients Receiving Continuous Renal Replacement Therapy or Intermittent Hemodialysis, Pharmacotherapy 2009
7. Aranoff GR et al., Drug Prescribing in Renal Failure, 5 th edition, American College of Physicians, Philadephia, 2007
8. Trotman RL et al, Antibiotic Dosing in Critically Ill Adult Patients Receiving Continuous Renal Replacement Therapy, CID 2005
9. Guglielmo BJ et al., Ceftriaxone Therapy for Staphylococcal Osteomyelitis, CID 2000
10. Pai MP et al, Influence of Morbid Obesity on the Single–Dose Pharmacokinetics of Daptomycin,AAC 2007
11. Dvorchik BH and Damphousse,D,The Pharmacokinetics of Daptomycin in Moderately Obese, Morbidly Obese, and Matched Nonobese Subjects, Journal of Clinical Pharmacology, 2005
12. ATS Guidelines for Treatment of Tuberculosis, Am J RespirCrit Care Med Vol 167. pp 603–662, 2003
13. Baddour et al , Infective Endocarditis: Diagnosis and Management, Circulation. 2005
14. Zimmerli W et al., Role of Rifampin for Treatment of Orthopedic Implant–Related Staphylococcal Infections, JAMA 1998
15. http://www.cdc.gov/H1N1flu/recommendations.htm
16. Robson R, et al. The pharmacokinetics and tolerability of oseltamivir suspension in patients on hemodialysis and continuous ambulatory peritoneal dialysis Nephrol Dial Transplant 2006;21:2556–62.
17. Taylor RJ et al. Oseltamivir is adequately absorbed following nasogastric administration to adult patients with severe H5N1 influenza. PLoS ONE 2008;3:e3410.
18. Kuti et al., Use of Monte Carlo Simulation to Design an Optimized Pharmacodynamic Dosing Strategy for Meropenem, J ClinPharmacol2003 43: 1116
19. Rybak M, Lomaestro B, Rotschafer JC et al. Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health–System Pharmacists, the Infectious Diseases
Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health–Syst Pharm. 2009; 66:82–98
20. Nicolau DP et al, Experience with a Once–Daily Aminoglycoside Program Administered to 2,184 Adult Patients, AAC 1995; 39(3): 650–65
21. Liu et al, Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin–Resistant Staphylococcus Aureus Infections in Adults and Children, Clinical Infectious
Diseases 2011;1–38
22. Patel N et al, Identification of optimal renal dosage adjustments for traditional and extended-infusion piperacillin-tazobactam dosing regimens in hospitalized patients. Antimicrob Agents Chemother 2012;
54(1):460-5.
23. Koselke E et al. Evaluation of the effect of obesity on voriconazole serum concentration. J Antimicrob Chemotherapy. Dec 2012;67(12):2957-62.