In the setting of rapidly improving or worsening renal function, calculations of CrCl are inaccurate. Dosing should be based on estimated renal function instead.
If improving renal function, actual CrCl is likely higher than calculated CrCl.
If worsening renal function, actual CrCl is likely lower than calculated CrCl.
Not On Dialysis
400mg IV q24h
500mg PO q24h
PNA/Bone-Joint/Febrile Neutropenia: 400 mg IV q12h, 500-750 mg PO q24h
Pyelo/Severe UTI, IA: 400 mg IV q24h, 500 mg PO q24h
Cystitis: 200 mg IV q24h, 250 mg PO q24h
Usual adult dose
Intermittent Dialysis
400mg IV or 500mg PO q24h
Dose after HD on dialysis days
Continuous Dialysis
400mg IV q12h