In the setting of rapidly improving/worsening renal function, calculations of eGFR are inaccurate, and dosing should be based on estimated renal function instead.
If worsening renal function, actual GFR is likely lower than calculated.
If improving renal function, actual GFR is likely higher than calculated eGFR.
eGFR 0 - 20
2.25g IV q8h
Use q6h dosing for HAP or VAP
eGFR 20 - 40
2.25 g IV q6h
Use 3.375g IV q6h dosing for HAP or VAP
eGFR > 40
3.375 - 4.5 g IV q6h
2.25g IV q8h, plus supplemental dose of 0.75g IV after dialysis
2.25 g every 12 hours
Use 2.25 g every 8 hours for HAP or VAP
3.375g IV q6h
Depends on type of renal replacement therapy used
Pharmacist consult recommended