Trimethoprim-Sulfamethoxazole - Renal - Adult Dosing

  • Use adjusted body weight for dosing

  • May consider TBW for serious infections

  • TMP/SMX has high oral bioavailability – consider initiating with/switching to oral therapy when patient tolerating orals

  • When switching to oral therapy, consider that a single-strength tablet has 80mg of TMP, a double-strength tablet 160mg of TMP.

CrCl >50 mL/min

10 mg TMP/kg/day IV divided Q6 - 12h

CrCl 10 - 50 mL/min

5 - 7.5 mg TMP/kg/day IV divided Q12 - 24h

CrCl <10 mL/min (ESRD not on HD)

2.5 - 5.0 mg TMP/kg IV Q24h

Dialysis (HD)

2.5-5mg TMP/kg/day Q24h

Dialysis (CRRT)

5-7.5mg TMP/kg/day divided Q12-24h

CrCl >50 mL/min

15 - 20 mg TMP/kg/day IV divided Q6 - 12h

CrCl 10 - 50 mL/min

10 - 15 mg TMP/kg/day IV divided Q12 - 24h

CrCl <10 mL/min (ESRD not on HD)

5 - 10 mg TMP/kg IV Q24h

Dialysis (HD)

2.5-5mg TMP/kg/day Q24h

Dialysis (CRRT)

5-7.5mg TMP/kg/day divided Q12-24h