Anti-Infectives Dosing Flashcards
What is the initial conventional dosing of gentamicin?
1.5-2mg/kg per dose Q8H based on ideal or adjust body weight
What is the initial extended-interval dosing of gentamicin?
5-7mg/kg per day based on ideal or adjust body weight
What is the renal dosage adjustment for gentamicin?
Individualized based on CrCL and therapeutic drug monitoring
What peak ranges are associated with efficacy for gentamicin?
5-10mcg/mL
What trough ranges are associated with decreased nephrotoxicity for gentamicin?
Less than 1-2mcg/mL
How is gentamicin extended interval dosing monitored?
Via nomograms with concentrations measured 6-14 hours from time of administration
How does tobramycin IV dosing compare to gentamicin?
Same
What is tobramycin inhalation dosing for preventing exacerbations in cystic fibrosis patients?
300mg every 12 hours
-should not be used as monotherapy to treat pneumonia
Which organism does tobramycin have slightly better activity against vs gentamicin?
Pseudomonas aeruginosa
Which organism does gentamicin have slightly better activity against vs tobramycin?
- Klebsiella pneumoniae
- Gram positive organisms
What is the adult dosing of cefprozil?
250-500mg BID
What is the pediatric dosing of cefprozil?
7.5mg/kg BID
or
20mg/kg daily, depending on the indication
What is the renal dosage adjustment of cefprozil?
Reduce dose by 50% with a CrCL less than 30 mL/min
What is the adult dosing of cefdinir?
Most indications: 300mg BID
or
600mg QD
What is the pediatric dosing of cefdinir?
7mg/kg/dose BID
or
14mg/kg/dose QD
What is the renal dosage adjustment of cefdinir?
300mg QD if CrCL less than 30 mL/min
What is the adult ceftriaxone dosing for most indications?
1-2g QD
Maximum daily dose of 4g
What is the adult ceftriaxone dosing for meningitis?
2g IV Q12H
What is the adult ceftriaxone dosing for gonorrhea?
250mg IM once
What is the pediatric ceftriaxone dosing for mild to moderate infections?
50-75mg/kg daily (divided QD or BID)
Maximum daily dose of 2g
What is the pediatric ceftriaxone dosing for meningitis?
100mg/kg daily (divided QD or BID)
Maximum daily dose of 4g
What is the adult cefuroxime dosing for most indications?
250-500mg BID
What is the pediatric (younger than 12 yo) cefuroxime dosing for most indications?
20-30mg/kg/day divided into 2 doses
Max daily dose: 1g
What is the renal dosage adjustment of cefuroxime?
Dose every 24 hours with a CrCL less than 30mL/min
What is the adult cephalexin dosing for most indications?
1-4g daily in divided doses
Most commonly: 250mg QID
What is the pediatric cephalexin dosing for most indications?
25-100mg/kg/day in 2-4 divided doses (max daily dose: 4g)
What is the pediatric cephalexin dosing for acute otitis media?
75-100mg/kg/day in 4 divided doses
What is the renal dosage adjustment of cephalexin?
Adjust for CrCL less than 60mL/min
What is the adult cefepime dosing for most indications?
2g Q8-12H
What is the pediatric cefepime dosing for most indications?
50mg/kg/dose Q8-12H
Maximum: 2g/dose
What is the renal dosage adjustment of cefepime?
Adjust for CrCL less than 60mL/min
What two indications does cefuroxime have that cefprozil does not have?
- UTIs
- Lyme disease
What indications do cefprozil and cefuroxime share?
- upper and lower RTIs
- uncomplicated skin/structure infections
- tonsillitis
What indications does ceftriaxone have?
- upper/lower RTIs
- skin/structure infections
- UTIs
- gonorrhea
- pelvic inflammatory disease
- bacteremia
- endocarditis
- bone/joint infections
- intra-abdominal infections
- meningitis
- surgical prophylaxis
- Lyme disease
What is daptomycin dosing for skin/structure infections?
4mg/kg daily
What is daptomycin dosing for bacteremia and endocarditis?
6mg/kg daily
What dose of daptomycin is recommended by some experts in cases of complicated MRSA bacteremia and endocarditis?
8-10mg/kg daily
What is the renal dosage adjustment of daptomycin?
Administer QOD if CrCL less than 30mL/min
What is the adult oral ciprofloxacin dosing for most indications?
250-750mg BID depending on location and severity of infection
What is the adult oral ER ciprofloxacin dosing for UTIs?
500-1000mg daily
What is the adult IV ciprofloxacin dosing for most indications?
200-400mg BID or TID depending on location and severity of infection
What is the renal dosage adjustment of ciprofloxacin?
Required with CrCL of less than 30-50mL/min
What is the adult oral levofloxacin dosing for most indications?
250-750mg QD depending on indication
What is the renal dosage adjustment of levofloxacin?
Decreased dose depending on whether CrCL is 20-49mL/min or 10-19mL/min
What is the adult oral moxifloxacin dosing for most indications?
400mg QD
What is the renal dosage adjustment of moxifloxacin?
Not necessary
-excreted via the biliary tract
What is the adult Bactrim dosing for most indications?
1 DS tablet BID
What is the adult Bactrim dosing for UTIs?
1 DS tablet BID
What is the adult Bactrim dosing for Pneumocystis prophylaxis?
1 DS tablet QD or TIW
1 SS tablet QD
What is the adult Bactrim dosing for Toxoplasmosis prophylaxis?
1 DS tablet QD
What is the adult Bactrim dosing for Toxoplasmosis treatment?
5mg/kg BID
What is the adult Bactrim dosing for P. jirovecci pneumonia?
15-20mg/kg/day based on trimethoprim divided TID-QID
What is the pediatric Bactrim dosing for most indications?
8-10mg/kg/day based on trimethoprim divided TID-QID
What is the pediatric Bactrim dosing for P. jirovecci pneumonia?
Same as adult dosing
What is the renal dosage adjustment of Bactrim?
50% of usual dose if CrCL of 15-30mL/min
What is the oral vancomycin dosing?
125-500mg Q6H
What is the adult injection vancomycin dosing?
15-20mg/kg BID
What is the pediatric injection vancomycin dosing?
10mg/kg/dose Q6H
What is the infant injection vancomycin dosing?
Loading dose: 15mg/kg
Followed by:
-10mg/kg Q12H (first week of life)
-10mg/kg Q8H (1 week to 1 month of life)
What is vancomycin dosing determined by?
- patient characteristics
- infection severity
- renal function
What is the renal dosage adjustment of vancomycin?
Most clinicians reduce IV dose at CrCL of 50-60mL/min
What is a therapeutic vancomycin trough?
10-20mg/L
Depends on:
-characteristics of infecting organism
-type of infection
What vancomycin troughs are associated with nephrotoxicity?
Greater than 15-20mg/L
Are vancomycin peaks routinely monitored?
No
-evidence correlating concentrations with efficacy is imperfect