Pregnancy: Category B (no evidence of risk in humans)
Lactation: very small amount excreted, adverse effects unlikely, infant should be monitored closely
Renal Dosing
Adult
febrile neutropenia
GFR 30-60: 2g q12h
GFR 11-29: 2g q24h
GFR < 11: 2g x1, then 1g q24h
HD: 1g q24, give after dialysis
PD: 2g q24h
all other infections
GFR 30-60: q24h dosing
GFR 11-29: give usual dose x1, then 0.5-1g q24
GFR < 11: give usual dose x1, then 250-500mg q24h
HD: 1g x1, then 500mg q24h, give after dialysis
PD: usual dose q48h
Pediatric
febrile neutropenia, cystic fibrosis
GFR 30-60: 50mg/kg q12h
GFR 11-29: 50mg/kg q24h
GFR < 11: 50mg/kg x1, then 25mg/kg q24
HD: 25mg/kg q24, give after dialysis
PD: 50mg/kg q48
all other infections
GFR 30-60: 50mg/kg q24
GFR 11-29: 50mg/kg x1, then 25-50mg/kg q24
GFR < 11: 50mg/kg x1, then 12.5-25mg/kg q24h
HD: 50mg/kg x1, then 25mg/kg q24h, give after dialysis
PD: 50mg/kg q48h
Hepatic Dosing
Adult: no adjustment
Pediatric: no adjustment
Adult
febrile neutropenia
GFR 30-60: 2g q12h
GFR 11-29: 2g q24h
GFR < 11: 2g x1, then 1g q24h
HD: 1g q24, give after dialysis
PD: 2g q24h
all other infections
GFR 30-60: q24h dosing
GFR 11-29: give usual dose x1, then 0.5-1g q24
GFR < 11: give usual dose x1, then 250-500mg q24h
HD: 1g x1, then 500mg q24h, give after dialysis
PD: usual dose q48h
Pediatric
febrile neutropenia, cystic fibrosis
GFR 30-60: 50mg/kg q12h
GFR 11-29: 50mg/kg q24h
GFR < 11: 50mg/kg x1, then 25mg/kg q24
HD: 25mg/kg q24, give after dialysis
PD: 50mg/kg q48
all other infections
GFR 30-60: 50mg/kg q24
GFR 11-29: 50mg/kg x1, then 25-50mg/kg q24
GFR < 11: 50mg/kg x1, then 12.5-25mg/kg q24h
HD: 50mg/kg x1, then 25mg/kg q24h, give after dialysis
PD: 50mg/kg q48h
febrile neutropenia
GFR 30-60: 2g q12h
GFR 11-29: 2g q24h
GFR < 11: 2g x1, then 1g q24h
HD: 1g q24, give after dialysis
PD: 2g q24h
all other infections
GFR 30-60: q24h dosing
GFR 11-29: give usual dose x1, then 0.5-1g q24
GFR < 11: give usual dose x1, then 250-500mg q24h
HD: 1g x1, then 500mg q24h, give after dialysis
PD: usual dose q48h
GFR 30-60: 2g q12h
GFR 11-29: 2g q24h
GFR < 11: 2g x1, then 1g q24h
HD: 1g q24, give after dialysis
PD: 2g q24h
GFR 30-60: q24h dosing
GFR 11-29: give usual dose x1, then 0.5-1g q24
GFR < 11: give usual dose x1, then 250-500mg q24h
HD: 1g x1, then 500mg q24h, give after dialysis
PD: usual dose q48h
febrile neutropenia, cystic fibrosis
GFR 30-60: 50mg/kg q12h
GFR 11-29: 50mg/kg q24h
GFR < 11: 50mg/kg x1, then 25mg/kg q24
HD: 25mg/kg q24, give after dialysis
PD: 50mg/kg q48
all other infections
GFR 30-60: 50mg/kg q24
GFR 11-29: 50mg/kg x1, then 25-50mg/kg q24
GFR < 11: 50mg/kg x1, then 12.5-25mg/kg q24h
HD: 50mg/kg x1, then 25mg/kg q24h, give after dialysis
PD: 50mg/kg q48h
GFR 30-60: 50mg/kg q12h
GFR 11-29: 50mg/kg q24h
GFR < 11: 50mg/kg x1, then 25mg/kg q24
HD: 25mg/kg q24, give after dialysis
PD: 50mg/kg q48
GFR 30-60: 50mg/kg q24
GFR 11-29: 50mg/kg x1, then 25-50mg/kg q24
GFR < 11: 50mg/kg x1, then 12.5-25mg/kg q24h
HD: 50mg/kg x1, then 25mg/kg q24h, give after dialysis
PD: 50mg/kg q48h
Adult: no adjustment
Pediatric: no adjustment
Cefipime
Meropenem
Cefepime
Azithromycin
Levofloxacin
Aztreonam
Cefotaxime
Cefazolin