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
500mg IV Q6h or 1000mg IV Q8h
CrCl 10-29 mL/min
500mg IV Q12h
CrCl <10 mL/min
Should not receive unless HD to be initiated
500-1000mg IV Q24h (doses given on HD days should be given after HD)
500mg IV Q24h