Critically Ill Patients with Renal Hyperfiltration: Optimizing Antibiotic Dose

Table 5

Antibiotic dosage in patients with RHF. Modified from Tomasa Irrigable [28].

Drug	Usual doses (normal GFR) (Mesa 2017)	Suggested dose for HRF	Special cases
Levofloxacin	500 mg IV every 24 hours	750 mg IV every 24 hours	For S. pneumoniae infections, P. aeruginosa and S. aureus 1,000 mg/24 h iv
Meropenem	1 g IV every 8 hours	2 g IV C/8 h2	Doses of up to 8 g per day may be required [2]
Cefepime	1-2 g IV every 8–12 hours	2 g IV every 8 h prolonged infusion 3 h^3
Piperacillin/Tazobactam	2–4 g IV every 6–8 hours maximum dose 4 g IV every 4 h	4.5 g/4–6 hrs prolonged infusion of 4 h^2	36 g/day may be needed to achieve the therapeutic goal
Vancomycin	15–20 mg/kg/every 8–12 noon IV Maximum 4 g/day	45 mg/kg/day spread over 3 doses or in continuous infusion	According to the nomogram and RHF stratification, if mild RHF (CrCl 130–150 ml/min) give the highest recommended dose habitually. If moderate RHF (CrCl 150–200 ml/min) give between 3 and 4 g/day. If high ARC (CrCl 200–250 ml/min) give between 4 and 4.5 g/day. If very high ARC (CrCl 250–300 ml/min) give between 4.5 and 5.5 g/day If extreme ARC (CrCl > 300 ml/min) give 6 g/day