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Antibiotic	GFR (mL/min)			Comments
	Mild 50-20	Moderate 20-10	Severe < 10
*Aciclovir	Normal dose every 12h	normal dose every 24h	50% of normal dose every 24h	Give postHD
Aciclovir po	normal	Herpes simplex: normal Herpes zoster: 800mg Total Dissolved Solids tds	Herpes simplex: 200mg bid Herpes zoster: 800 mg bd	Give postHD
Amikacin	5-6mg/kg 12h	3-4mg/ kg 24h HD: 5mg/ kg post HD and monitor levels	2mg/kg 24-48h	Give post-HD Monitor preand 1h postdose levels after 3rd dose and adjust dose as required
Amoxicillin po	normal	normal	250mg 8h (normal)	Give postHD
Amphotericin	normal	normal	normal
(Liposonal+ lipid complex)	Amphotericin is highly NEPHROTOXIC. Consider using liposomal/lipid complex amphotericin. Daily monitoring of renal function (GFR) essential.
Ampicillin IV	normal	250-500mg 6h	250mg 6h (500mg 6h)	Give postHD
Benzylpenicillin	Normal	75%	0-50% Max. 3.6g/ day (1.2g qds)	Give postHD Refer to microbiology for dosing in SBE
Caspofungin	normal	normal	normal
Cefotaxime	normal	normal	1g stat then 50%	Give postHD
Cefradine	normal	normal	250mg 6h	Give postHD
Ceftazidime	1g 12h	1g 24h	500mg 24h (1g 24h)	Give postHD
Ceftriaxone	normal	normal	normal Max. 2g/day
Cefuroxime IV	normal	750mg-1.5g 12h	750mg 24h (750mg 12h)	Give postHD
Ciproflazin IV+po	normal	50%	50%
Clarithromycin IV+po	normal	normal	50%	Give postHD
Clindamycin IV+po	normal	normal	normal
Coamoxiclav IV (Augmentin)	normal	1.2 stat then 50% 12h (1.2g 12h)	1.2 stat then 50% 24h (1.2g stat then 600mg 12h)	Give postHD
Coamoxiclav po (Augmentin)	normal	375-625mg 12h (375mg 8h)	375mg 12h (375mg 8h)	Give postHD
Cotrimoxazole IV	normal	Normal for 3/7 then 50%	50%	Give postHD
Doxycycline contraindicated	normal	normal	normal	All other tetracyclines contraindicated in renal impairment
Erythromycin IV+po	normal	normal	normal Max. 1.5g/ day (500mg qds) *
*Ethambutol	normal	24-36h	48h	Give postHD
	Monitor levels if GFR < 30mL/min (contact Mirco)
Flucloxacillin IV+po	normal	normal	normal Max. 4g/day
Fluconazole	normal	normal	50%	Give post-HD No adjustments in single-dose therapy required
*Flucytosine	50mg/kg 12h	50mg/kg 24h	50mg/kg stat thendose according to levels	Give post-HD Levels should be monitored predialysis.
Fusidic acid	normal	normal	normal
1) Gentamicin ONCE DAILY	GFR 10-40mL/min 3mg/kg stat (max. 300mg) Check pre-dose levels 18- 24h after first dose Redose only when level < 1mg/L		GFR < 10mL/ min 2mg/kg (max. 200mg) redose according to levels	BOTH METHODS Give postHD Monitor blood levels:
2) Gentamicin CONVENTIONAL	80mg 12h 80mg 48h		80mg 24h HD: 1-2mg/ kg Post-HD: redose according to levels	Once daily: pre only Conventional: pre and 1 h post level required.
Imipenem	500mg 8-12h	250-500mg bid	Risk of convulsions - use Meropenem: see below	Give postHD
Isoniazid	normal	normal	200-300mg 24h	Give postHD
Itraconazole	normal	normal	normal
Levoflaxacin	500mg stat then 250mg bid**	500mg stat then 125mg bid**	500mg stat then 125mg od	**Applies if full dose is 500 mg bid If full dose is 500 mg od, five reduced doses daily
Linezolid	normal	normal	normal	Give postHD
Meropenem	12h	50% 12h	50% 24h	Give postHD
Metronidazole	normal	normal	12h (normal)	Give postHD
Nitrofurantoin	Do NOT use in renal impairment
Penicillin V	normal	normal	normal	Give postHD
Piperacillin/ Tazobactam (Tazocin)	4.5g 8h	4.5g 12h	4.5g 12h	Give postHD
Pyrazinamide	normal	normal	normal
Rifampicin	normal	normal	50-100%
*Teicoplanin	100% 48h	100% 72h	100% 72h	Dose reduction after day 3 of therapy