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Guidelines
SMZ/TMP Renal Dosing

SMZ/TMP Renal Dosing

Note

800/160 mg = 1 DS tab = 20 mL oral solution = 10 mL IV

pO₂<70 mm Hg on room air or arterial-alveolar O₂ gradient >35 mm Hg

Not On Dialysis

  • CrCl >50 mL/min: 1 DS tab BID

  • CrCl 30-50 mL/min: 1 DS tab BID

  • CrCl 10-29 mL/min: 1 SS tab BID

  • CrCl <10 mL/min: 1 DS tab daily

  • CrCl >50 mL/min: 2 DS tab BID

  • CrCl 30-50 mL/min: 2 DS tab BID

  • CrCl 10-29 mL/min: 1 DS tab BID

  • CrCl <10 mL/min: 1 DS tab daily

  • CrCl >50 mL/min: 5mg/kg q12hr

  • CrCl 30-50 mL/min: 5mg/kg q12hr

  • CrCl 10-29 mL/min: 5mg/kg q12hr

  • CrCl <10 mL/min: 5mg/kg q24hr

  • CrCl ≥30 mL/min: 1 DS tab daily (preferred in HIV population) OR 1 SS tab daily OR 1 DS tab 3x/week

  • CrCl <30 mL/min:

    • HIV: 1 SS tab daily
    • BMT: 1 SS tab 3x/week
    • SOT: 1 SS tab 3x/week or 1 SS tab q48h
    • Close monitoring for CrCl < 15mL/min

  • CrCl ≥30 mL/min:

    • Mild/mod: 2 DS tab TID or 5mg/kg q8hr
    • Mod/severe: 5mg/kg q8hr

  • CrCl 10-29 mL/min:

    • Mild/mod: 2 DS tab BID or 5mg/kg q12hr
    • Mod/severe: 5mg/kg q12hr

  • CrCl <10 mL/min:

    • Mild/mod: 2 DS tab daily or 5mg/kg q24hr
    • Mod/severe: 5mg/kg q24hr

  • CrCl >50 mL/min: 5mg/kg q8hr

  • CrCl 30-50 mL/min: 5mg/kg q8hr

  • CrCl 10-29 mL/min: 5mg/kg q12hr

  • CrCl <10 mL/min: 5mg/kg q24hr

Intermittent Hemodialysis (IHD)

1 DS tab qPM

Use Cautiously

5mg/kg q24hr (qPM for HD)

1 SS tab 3x per week

Dose in PM for HD

Mild/mod: 2 DS tab daily or 5mg/kg q24hr

Mod/severe: 5mg/kg q24hr

Dose in PM for HD

Continuous Ambulatory Peritoneal Dialysis (CAPD)

1 DS tab daily

1 DS tab daily

Use Cautiously

5mg/kg q24hr (qPM for HD)

1 SS tab 3x per week

Dose in PM for HD

Mild/mod: 2 DS tab daily or 5mg/kg q24hr

Mod/severe: 5mg/kg q24hr

Dose in PM for HD

Continuous Renal Replacement Dosing

2.5mg/kg q8h (round to nearest tablet size for PO)