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
Usual adult dose
Intermittent Dialysis
Give doses after HD on HD days, if possible
Continuous Dialysis
Load 2g then 1-2g IV q6h