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
250-1000mg PO Q6h
CrCl 10-29 mL/min
250mg PO Q8-12h
CrCl <10 mL/min
250-500mg PO Q24-48h
250-500mg PO Q24-48h (doses given on HD days should be given after HD)