• Dosing recommendations are based on creatinine clearance calculated using the Cockcroft-Gault equation.
• Do not use eGFR estimates (available on PAS) for drug dosing purposes (for more information  click here )
• To calculate creatinine clearance (CrCl) using the Cockcroft-Gault equation, use the creatinine clearance calculator :
• Accurate estimation of CrCl is only possible in patients with STABLE renal function. In patients with rapidly changing renal function (i.e. ACUTE renal failure), the serum creatinine levels will no longer provide a true reflection of renal function.
• Dose adjustment may not be appropriate in ACUTE renal impairment secondary to SEPSIS. In this case it is important to treat the infection aggressively for the first 24hrs and re-check renal function before reducing the dose accordingly.
• (In 'acute on chronic' renal impairment the initial dose should correspond to the previous level of chronic renal impairment).

Crcl (ml/min)	Dose
20 – 50	Normal loading dose then 600mg od
10 – 20	Normal loading dose then 400mg od
<10	Normal loading dose then 200mg od

 

Loading dose = 400mg every 12 hours for 3 doses Further dosing is every 24 hours starting 12 to 18 hours after the last loading dose (click here for example prescription) Take a pre-dose level on the 5th day if treatment is likely to continue beyond 7 days, otherwise monitoring of levels is not required The Consultant Microbiologist will advise on repeat sampling, if indicated

 

Refer to Renal Pharmacist or Medicines Information for advice on dosing in haemodialysis and peritoneal dialysis.