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 >50 mL/min
2000mg IV Q4-6h
CrCl 10-50 mL/min
2000mg IV Q6-12h
CrCl <10 mL/min
2000mg IV Q12-24h
1000-2000mg IV Q12-24h (doses given on HD days should be given after HD)
Load 2000mg IV, then 1000-2000mg IV Q6-12h