In the setting of rapidly improving or worsening renal function, calculations of CrCl are inaccurate. Dosing should be based on estimated renal function instead.
If improving renal function, actual CrCl is likely higher than calculated CrCl.
If worsening renal function, actual CrCl is likely lower than calculated CrCl.
CrCl ≥30 mL/min
1500-3000mg IV Q6h
CrCl 10-29 mL/min
1500-3000mg IV Q12h
CrCl <10 mL/min
1500-3000mg IV Q24h
1500-3000mg IV Q12-24h (doses given on HD days should be given after HD)
Load 3000mg IV, then 1500-3000mg IV Q6-12h