| Antimicrobial |
Normal Adult Dose |
Dose and Interval Adjustment for Renal Impairment |
| Creatinine Clearance (mL/min) |
|---|
| >50 |
10 - 50 |
<10 (Anuric) |
| Amphotericin B |
0.5-1 mg/kg IV daily |
q24h |
q24h |
q24-36h |
| Anidulafungin |
200mg IV once then 100mg IV daily |
NO CHANGE NEEDED |
| Caspofungin |
70mg IV once then 50mg IV daily |
NO CHANGE NEEDED |
| Fluconazole |
400mg PO/IV daily |
q24h |
q24-48h |
q48-72h |
| Flucytosine |
37.5mg/kg PO q6h |
q12h |
q12-24h |
q24h |
| Isavuconazole |
200mg PO/IV daily |
NO CHANGE NEEDED |
| Itraconazole |
100-200 mg PO daily |
NO CHANGE NEEDED |
| Ketoconazole |
200-400 mg PO daily |
NO CHANGE NEEDED |
| Micafungin |
100mg IV daily |
NO CHANGE NEEDED |
| Posaconazole |
400mg PO bid |
NO CHANGE NEEDED |
| Voriconazole |
4mg/kg IV q12h |
NO CHANGE NEEDED |
Accumulation & resultant toxicity of the diluent can occur if Clcr < 50mL/min. Use oral voriconazole at normal doses. |
| |
200mg PO q12h |
NO CHANGE NEEDED |
