In the setting of rapidly improving/worsening renal function, calculations of eGFR are inaccurate, and dosing should be based on estimated renal function instead.
If worsening renal function, actual GFR is likely lower than calculated.
If improving renal function, actual GFR is likely higher than calculated eGFR.
0 - 10 eGFR
2.5-5mg/kg IV q24h
10 - 25 eGFR
5-10mg/kg IV q24h
25 - 50 eGFR
5-10mg/kg IV q12h
5-10mg/kg IV q8h
2.5-5 mg/kg IV q24h post dialysis on IHD days (higher dose for CNS infection)
5-7.5mg/kg IV q24h. Use upper end for CNS infections