Mika Note

商品名

學名

劑量調整

Phel

Cephalexin (1g)

CrCl >30 mL/minute: 500 mg-1 g every 6 hours

CrCl 10-29: 500 mg-1 g every 8-12 hours

CrCl <10: 500 mg-1 g every 24 hours

Hemodialysis: 500 mg-1 g every 24 hours; moderately dialyzable (20% to 50%); give dose after dialysis session (以透析完時間點為基準，1/2-1 vial QD) (非只有透析當天給)

Cefa

Cephazolin (1g)

CrCl 35-54 mL/minute: Administer full dose in intervals of ≥8 hours

CrCl 11-34 mL/minute: Administer 50% of usual dose every 12 hours

CrCl ≤10 mL/minute: Administer 50% of usual dose every 18-24 hours

Intermittent hemodialysis (IHD) (administer after hemodialysis on dialysis days): Dialyzable (20% to 50%): 500 mg to 1 g QD or

1-2 g every 48-72 hours or

15-20 mg/kg (maximum dose: 2 g) after dialysis 3 times weekly or

2 g after dialysis if next dialysis expected in 48 hours or

3 g after dialysis if next dialysis is expected in 72 hours

Lofadine

Cephradine (1g)

Lack information

Gibicef

Cefuroxime (1g)

CrCl >20 mL/minute: No dosage adjustment necessary.

CrCl 10-20 mL/minute: Administer every 12 hours.

CrCl <10 mL/minute: Administer every 24 hours

(以透析完時間點為基準，1-1.5 vial QD) (非只有透析當天給)

Cetalin

Ceftriaxone (1g)

No dosage adjustment is generally necessary in renal impairment; Note: Concurrent renal and hepatic dysfunction: Maximum dose: ≤2 g daily

Poorly dialyzed; no supplemental dose or dosage adjustment necessary

Cefulin

Ceftazidime (1g)

CrCl > 50 mL/minute: 2g every 8 hours

CrCl 30 to 49 mL/minute: 2 g every 12 hours

CrCl 10 to 29 mL/minute: 2 g every 24 hours

CrCl <10 mL/minute: 1 g every 24 hours

Intermittent hemodialysis (IHD) (administer after hemodialysis on dialysis days): Dialyzable (50% to 100%): 1 g every 24 hours

(以透析完時間點為基準，1 vial QD) (非只有透析當天給)

Anbicyn

Amoxicillin/Clavulanate (1.2g)

Dose is based on the amoxicillin component

CrCl <30 mL/minute: Do not use 875 mg tablet or extended release tablets.

CrCl 10-29 mL/minute: 1.2 g every 12 hours or initial 1.2 g then 0.6 g Q12H

CrCl <10 mL/minute: 1.2 g every 24 hours or initial 1.2 g Q24H

Hemodialysis: Moderately dialyzable (20% to 50%) 1.2 g every 24 hours; administer dose during and after dialysis.

(以透析完時間點為基準，1 vial QD) (非只有透析當天給)

Asullina

Ampicillin/Sulbactam (1.5g)

Dose is based on the complete Ansullina

CrCl 10 to 29 mL/minute/1.73 m2: 1.5-3 g every 12 hours

CrCl <10 mL/minute/1.73 m2: 1.5-3 g every 24 hours

Intermittent hemodialysis (IHD) (administer after hemodialysis on dialysis days): 1.5 to 3 g every 24 hours

(以透析完時間點為基準，1 vial QD) (非只有透析當天給)

Betamycin

Piperacillin/Tazobactam (2.25g; 4.5g)

CrCl 20-40 mL/minute: 2.25 g Q6H or 4.5 g Q8H (3.375 g Q6H for nosocomial pneumonia)

CrCl <20 mL/minute: 2.25 g Q8H or 4.5 g Q12H (2.25 g Q6H for nosocomial pneumonia)

Intermittent hemodialysis (IHD)/peritoneal dialysis (PD): 2.25-4.5 g Q12H (2.25 g every 8 hours for nosocomial pneumonia)

Vanco

Vancomycin (500mg)

CrCl >50 mL/minute: Start with 15-20 mg/kg/dose (usual: 750-1500 mg) every 8-12 hours

CrCl 20-49 mL/minute: Start with 15-20 mg/kg/dose (usual: 750-1500 mg) every 24 hours

CrCl <20 mL/minute: Will need longer intervals; determine by serum concentration monitoring

Note: In the critically-ill patient with renal insufficiency, the initial loading dose (25-30 mg/kg) should not be reduced. However, subsequent dosage adjustments should be made based on renal function and trough serum concentrations.

Intermittent hemodialysis (IHD) (administer after hemodialysis on dialysis days): Following loading dose of 15-25 mg/kg, give either 500-1000 mg or 5-10 mg/kg after each dialysis session

or

CrCl >65: 1g or 15mg/kg every 12 hours

CrCl 35-64: 1g or 15mg/kg every 24 hours

CrCl 21-34: 1g or 15mg/kg every 2 days

CrCl 10-20: 1g or 15mg/kg every 3 days

CrCl <10: 1g or 15mg/kg every 4-7 days

HD/PD: 1g or 15mg/kg every 4-7 days

Redosing based on pre-HD concentrations:

<10 mg/L: Administer 1000 mg after HD

10-25 mg/L: Administer 500-750 mg after HD

>25 mg/L: Hold vancomycin

Redosing based on post-HD concentrations: <10-15 mg/L: Administer 500-1000 mg

Levox

Levofloxacin (5mg/ml, 100ml)

Normal renal function dosing of 500 mg daily:

CrCl 20-49 mL/minute: Administer 500 mg initial dose, followed by 250 mg every 24 hours

CrCl 10-19 mL/minute: Administer 500 mg initial dose, followed by 250 mg every 48 hours

Hemodialysis/chronic ambulatory peritoneal dialysis (CAPD): Administer 500 mg initial dose, followed by 250 mg every 48 hours; supplemental doses are not required following either hemodialysis or CAPD

Normal renal function dosing of 750 mg daily:

CrCl 20-49 mL/minute: Administer 750 mg every 48 hours.

CrCl 10-19 mL/minute: Administer 750 mg initial dose, followed by 500 mg every 48 hours.

Hemodialysis/chronic ambulatory peritoneal dialysis (CAPD): Administer 750 mg initial dose, followed by 500 mg every 48 hours; supplemental doses are not required following either hemodialysis or CAPD.

Tienam

Imipenem/Cilastatin (500mg/500mg)

Dose base on Imipenem

Patients with a CrCl ≤5 mL/minute/1.73 m2 should not receive imipenem/cilastatin unless hemodialysis is instituted within 48 hours.

Patients weighing <30 kg with impaired renal function should not receive imipenem/cilastatin

Intermittent hemodialysis (IHD) (administer after hemodialysis on dialysis days): Use the dosing recommendation for patients with a CrCl 6-20 mL/minute; administer dose after dialysis session and every 12 hours thereafter or 250-500 mg every 12 hours

Severe infections: I.V.:

Fully-susceptible organisms: 500 mg every 6 hours

Moderately-susceptible organisms: 1 g every 6-8 hours

Maximum daily dose should not exceed 50 mg/kg or 4 g/day, whichever is lower

Reduced I.V. dosage regimen based on creatinine clearance and/or body weight: See table.