| Dosificación de antimicrobianos en pacientes con insuficiencia renal Antimicrobiano | ClCr ml/min | >50 | 10-50 | <10 | Penicilinas, monobactámicos, carbapenemas | Penicilina G sódica | 2-4 M UI/4-6 h | 3-4 M UI/8 h | 2-3 M UI/8h | Ampicilina | 0,5-2g /6-8h | 0,5-2 g/12h | 0,5-2 g/12-24h | Cloxacilina | 0,5-2g/4-6h | 0,5-2g/4-6h | 0,5-2 g/6-8h | Amoxicilina / clavulánico | 1-2 g/6-8h | 0,5-1 g/12-18h | 0,5-1 g/24h | Piperacilina / tazobactam | 4 g/4-6h | 1,5-3 g/6-8h | 3-4 g/12h | Aztreonam | 1-2 g/6-8h | 1-2 g/12-18h | 1-2 g//24h | Ertapenem | 1 g/24 | 0,5 g/24h | 0,5 g/24h | Imipenem-cilastatina | 0,5-1 g/6h | 0,5-1 g/8-12h | 0,25-0,5 g/12h | Meropenem | 1-2 g/8h | 0,5-1 g/12h | 0,5-1 g/24h |
Antimicrobiano | ClCr ml/min | >50 | 10-50 | <10 | Cefalosporinas | Cefazolina | 0,5-2 g/6-8h | 0,5-1 g/8-12h | 0,25-0,5 g/24h | Cefuroxima | 0,75-1,5 g/8h | 0,75 g/12h | 0,75 g/12h | Ceftriaxona | 1-2 g/24h | 1-2 g/24h | 1-2 g/24h | Cefotaxima | 1-2 g/4-8h | 1-2 g/6-12h | 1-2 g/12-24h | Ceftazidima | 1-2 g/8h | 1-2 g/12h | 1 g/24-48h | Cefepima | 1-2 g/12h | 1 g/24h | 0,5 g/24h |
Antimicrobiano | ClCr ml/min | >50 | 10-50 | <10 | Otros | Gentamicina | 5 mg/kg/24h | 1,5 mg/kg/24h | 1,5 mg/kg/24-48h | Tobramicina | 5 mg/kg/24h | 1,5 mg/kg/24h | 1,5 mg/kg/24-48h | Amikacina | 15 mg/kg/24h | 9-12mg/kg/24h | 2-4 mg/kg/24h | Ciprofloxacino | 400 mg/8-12h | 400 mg/12h | 400 mg/24h | Levofloxacino | 500 mg/12- 24h | 250-500 mg/24h | 250-500 mg/48h | Moxifloxacino | 400 mg/24h | Igual | Igual | Vancomicina | 15 mg/kg/12h* | 1g /3-10 días* | 1 g/5-10 días* | Teicoplanina | 6-10 mg/kg/24h* | 6-10 mg/kg/48h* | 6-10 mg/kg/72h* | Doxiciclina | 100 mg/12-24h | 100 mg/24h | 100 mg/24h | Tigeciclina | 50 mg/12h* | Igual* | Igual* | Claritromicina | 500 mg/8-12h | 250 mg/12-24h | 250 mg/24h | Cotrimoxazol | 160-80 mg/12h | 80-40 mg/12h | 80-40 mg/24h | Clindamicina | 300-900 mg/8h | Igual | Igual | Metronidazol | 500 mg/8h | Igual | Igual | Colistina | 2-3 MU/8h* | 2-3 MU/12-24h* | 2-3 MU/36h* | Linezolid | 600 mg/12h | Igual | Igual | Daptomicina | 4-6 mg/kg/24h | 4-6 mg/kg/24h | 4-6 mg/kg/48h | Isoniacida | 300mg/dia | Igual | Igual | Rifampicina | 600 mg/24h | 300-600 mg/24h | 300-600 mg/24h | Pirazinamida | 15 mg/kg/24h | Igual | Evitar |
Antimicrobiano | ClCr ml/min | >50 | 10-50 | <10 | Antifúngicos | Fluconazol | 3-12 mg/kg/24h* | 1-4 mg/kg/24h* | 1-4 mg/kg/24h* | Voriconazol | 4 mg/kg/12h* | 4 mg/kg/12h* | Evitar | Posaconazol | 400 mg/12h* | Igual | Igual | Itraconazol | 200 mg/12h* | 200 mg/12h* | Evitar | Anfotericina B liposomal | 3-5 mg/kg/24h | Igual | Igual | Caspofungina | 50 mg/24h* | Igual* | Igual* | Micafungina | 100 mg/24 | Igual | Igual | Anidulafungina | 100 mg/24 | Igual | Igual | Flucitosina | 37,5-50 mg/kg/6h | 37,5-50 mg/kg/12-24h | 37,5-50 mg/kg/48h |
Antimicrobiano | ClCr ml/min | >50 | 10-50 | <10 | Antivirales | Aciclovir | 5 mg/kg/12h | 5 mg/kg/24h | 2,5 mg/kg/24h | Ganciclovir | 2,5-5 mg/kg/12h | 2,5 mg/kg/24h | 1,25 mg/kg/24h |
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