1. Loading dose for critically ill patient or severe infection:¶ 25 mg/kg (rounded to nearest 250 mg) | ||||||
2. Initial maintenance dose and interval: Based on target trough, patient weight, and estimated creatinine clearanceΔ as follows: | ||||||
Creatinine clearance in mL/minute (Cockcroft Gault equation)Δ | Weight (actual)◊ | |||||
50 to 59 kg | 60 to 69 kg | 70 to 79 kg | 80 to 89 kg | 90 to 99 kg | 100 kg◊ | |
Severe or deep-seated infection:§ Target trough 15 to 20 mcg/mL | ||||||
<10 (not receiving hemodialysis)¥ | Repeat dose when spot (random) serum concentration ≤20 mcg/mL | |||||
10 to 19 (not receiving hemodialysis)¥ | 750 mg every 48 hours | 1000 mg every 48 hours | 1000 mg every 48 hours | 1250 mg every 48 hours | 1250 mg every 48 hours | 1500 mg every 48 hours |
20 to 29 | 500 mg every 24 hours | 750 mg every 24 hours | 1000 mg every 36 hours | 1250 mg every 36 hours | 1250 mg every 36 hours | 1250 mg every 36 hours |
30 to 39 | 750 mg every 24 hours | 750 mg every 24 hours | 1000 mg every 24 hours | 1250 mg every 24 hours | 1250 mg every 24 hours | 1250 mg every 24 hours |
40 to 49 | 750 mg every 18 hours | 750 mg every 18 hours | 1000 mg every 18 hours | 1250 mg every 18 hours | 1250 mg every 18 hours | 1250 mg every 18 hours |
50 to 59 | 750 mg every 18 hours | 1000 mg every 18 hours | 1000 mg every 18 hours | 1250 mg every 18 hours | 1250 mg every 18 hours | 1500 mg every 18 hours |
60 to 69 | 750 mg every 12 hours | 750 mg every 12 hours | 1000 mg every 12 hours | 1000 mg every 12 hours | 1250 mg every 12 hours | 1250 mg every 12 hours |
70 to 79 | 750 mg every 12 hours | 1000 mg every 12 hours | 1000 mg every 12 hours | 1250 mg every 12 hours | 1250 mg every 12 hours | 1500 mg every 12 hours |
80 to 89 | 750 mg every 12 hours | 1000 mg every 12 hours | 1250 mg every 12 hours | 1250 mg every 12 hours | 1500 mg every 12 hours | 1500 mg every 12 hours |
90 to 99 | 1000 mg every 12 hours | 1000 mg every 12 hours | 1250 mg every 12 hours | 1500 mg every 12 hours | 1500 mg every 12 hours | 1500 mg every 12 hours |
≥100 and <60 years oldΔ | 750 mg every 8 hours | 750 mg every 8 hours | 1000 mg every 8 hours | 1250 mg every 8 hours | 1250 mg every 8 hours | 1250 mg every 8 hours |
Nonsevere and superficial infection:§ Target trough 10 to 15 mcg/mL | ||||||
<10 (not receiving hemodialysis)¥ | Repeat dose when spot (random) serum concentration ≤15 mcg/mL | |||||
10 to 19 (not receiving hemodialysis)¥ | 1000 mg every 72 hours | 1250 mg every 72 hours | 1250 mg every 72 hours | 1500 mg every 72 hours | 1500 mg every 72 hours | 1750 mg every 72 hours |
20 to 29 | 1000 mg every 48 hours | 1000 mg every 48 hours | 1250 mg every 48 hours | 1500 mg every 48 hours | 1500 mg every 48 hours | 1750 mg every 48 hours |
30 to 39 | 1000 mg every 36 hours | 1000 mg every 36 hours | 1250 mg every 36 hours | 1500 mg every 36 hours | 1500 mg every 36 hours | 1750 mg every 36 hours |
40 to 49 | 1000 mg every 24 hours | 1000 mg every 24 hours | 1250 mg every 24 hours | 1250 mg every 24 hours | 1500 mg every 24 hours | 1500 mg every 24 hours |
50 to 59 | 1000 mg every 24 hours | 1250 mg every 24 hours | 1250 mg every 24 hours | 1500 mg every 24 hours | 1500 mg every 24 hours | 1750 mg every 24 hours |
60 to 69 | 1000 mg every 18 hours | 1250 mg every 18 hours | 1250 mg every 18 hours | 1500 mg every 18 hours | 1500 mg every 18 hours | 1750 mg every 18 hours |
70 to 79 | 1000 mg every 18 hours | 1250 mg every 18 hours | 1250 mg every 18 hours | 1500 mg every 18 hours | 1500 mg every 18 hours | 1750 mg every 18 hours |
80 to 89 | 1000 mg every 18 hours | 1250 mg every 18 hours | 1250 mg every 12 hours | 1250 mg every 12 hours | 1500 mg every 12 hours | 1500 mg every 12 hours |
90 to 99 | 1000 mg every 12 hours | 1000 mg every 12 hours | 1250 mg every 12 hours | 1500 mg every 12 hours | 1500 mg every 12 hours | 1500 mg every 12 hours |
≥100 and <60 years oldΔ | 1000 mg every 12 hours | 1000 mg every 12 hours | 1250 mg every 12 hours | 1500 mg every 12 hours | 1500 mg every 12 hours | 1500 mg every 12 hours |
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