In the setting of rapidly improving/worsening renal function, calculations of eGFR are inaccurate, and dosing should be based on estimated renal function instead.
If worsening renal function, actual GFR is likely lower than calculated.
If improving renal function, actual GFR is likely higher than calculated eGFR.
Not On Dialysis: ODD (EGFR)
AVOID use. If necessary, use conventional aminoglycoside dosing
15 mg/kg q36h and consult pharmacy
15 mg/kg q24h
Not On Dialysis: MDD (eGFR)
Avoid
5 mg/kg q48h and consult pharmacy
5 mg/kg q48-24h and consult pharmacy
5 mg/kg IV q18-12h and consult pharmacy
5 mg/kg q8h
