Dosificación de antimicrobianos en pacientes con insuficiencia renal

 

AntimicrobianoClCr ml/min
>5010-50<10
Penicilinas, monobactámicos, carbapenemas
Penicilina G sódica2-4 M UI/4-6 h3-4 M UI/8 h2-3 M UI/8h
Ampicilina0,5-2g /6-8h0,5-2 g/12h0,5-2 g/12-24h
Cloxacilina0,5-2g/4-6h0,5-2g/4-6h0,5-2 g/6-8h
Amoxicilina / clavulánico1-2 g/6-8h0,5-1 g/12-18h0,5-1 g/24h
Piperacilina / tazobactam4 g/4-6h1,5-3 g/6-8h3-4 g/12h
Aztreonam1-2 g/6-8h1-2 g/12-18h1-2 g//24h
Ertapenem1 g/240,5 g/24h0,5 g/24h
Imipenem-cilastatina0,5-1 g/6h0,5-1 g/8-12h0,25-0,5 g/12h
Meropenem1-2 g/8h0,5-1 g/12h0,5-1 g/24h

 

AntimicrobianoClCr ml/min
>5010-50<10
Cefalosporinas
Cefazolina0,5-2 g/6-8h0,5-1 g/8-12h0,25-0,5 g/24h
Cefuroxima0,75-1,5 g/8h0,75 g/12h0,75 g/12h
Ceftriaxona1-2 g/24h1-2 g/24h1-2 g/24h
Cefotaxima1-2 g/4-8h1-2 g/6-12h1-2 g/12-24h
Ceftazidima1-2 g/8h1-2 g/12h1 g/24-48h
Cefepima1-2 g/12h1 g/24h0,5 g/24h

 

AntimicrobianoClCr ml/min
>5010-50<10
Otros
Gentamicina5 mg/kg/24h1,5 mg/kg/24h1,5 mg/kg/24-48h
Tobramicina5 mg/kg/24h1,5 mg/kg/24h1,5 mg/kg/24-48h
Amikacina15 mg/kg/24h9-12mg/kg/24h2-4 mg/kg/24h
Ciprofloxacino400 mg/8-12h400 mg/12h400 mg/24h
Levofloxacino500 mg/12- 24h250-500 mg/24h250-500 mg/48h
Moxifloxacino400 mg/24hIgualIgual
Vancomicina15 mg/kg/12h*1g /3-10 días*1 g/5-10 días*
Teicoplanina6-10 mg/kg/24h*6-10 mg/kg/48h*6-10 mg/kg/72h*
Doxiciclina100 mg/12-24h100 mg/24h100 mg/24h
Tigeciclina50 mg/12h*Igual*Igual*
Claritromicina500 mg/8-12h250 mg/12-24h250 mg/24h
Cotrimoxazol160-80 mg/12h80-40 mg/12h80-40 mg/24h
Clindamicina300-900 mg/8hIgualIgual
Metronidazol500 mg/8hIgualIgual
Colistina2-3 MU/8h*2-3 MU/12-24h*2-3 MU/36h*
Linezolid600 mg/12hIgualIgual
Daptomicina4-6 mg/kg/24h4-6 mg/kg/24h4-6 mg/kg/48h
Isoniacida300mg/diaIgualIgual
Rifampicina600 mg/24h300-600 mg/24h300-600 mg/24h
Pirazinamida15 mg/kg/24hIgualEvitar
AntimicrobianoClCr ml/min
>5010-50<10
Antifúngicos
Fluconazol3-12 mg/kg/24h*1-4 mg/kg/24h*1-4 mg/kg/24h*
Voriconazol4 mg/kg/12h*4 mg/kg/12h*Evitar
Posaconazol400 mg/12h*IgualIgual
Itraconazol200 mg/12h*200 mg/12h*Evitar
Anfotericina B liposomal3-5 mg/kg/24hIgualIgual
Caspofungina50 mg/24h*Igual*Igual*
Micafungina100 mg/24IgualIgual
Anidulafungina100 mg/24IgualIgual
Flucitosina37,5-50 mg/kg/6h37,5-50 mg/kg/12-24h37,5-50 mg/kg/48h

 

AntimicrobianoClCr ml/min
>5010-50<10
Antivirales
Aciclovir5 mg/kg/12h5 mg/kg/24h2,5 mg/kg/24h
Ganciclovir2,5-5 mg/kg/12h2,5 mg/kg/24h1,25 mg/kg/24h