Antibiotic Dosing

Question 1

Vancomycin

Answer 1

15-20 mg/kg q 8-12 hours

CrCl 20-49 give q 24 hours

Use AjBW in obese patients

Question 2

Gentamicin, Tobramycin

Answer 2

1-2.5 mg/kg q 24 hours if CrCl>60

Give q 36 hours of CrCl 40-60

Give q 48 hours if CrCl 20-40

Gentamicin sepsis: 3mg/kg/day divided q 8 hours

Gent trough <0.3

Question 3

Cefazolin

Answer 3

1-2 g q 8 hours (2g if > 80kg, CrCl>35)

CrCl 11-34, 1/2 dose q 12 hours

CrCl <10, 1/2 dose q 18-24 hours

Question 4

Ceftriaxone

Answer 4

1-2g q 12-24 hours

Question 5

Unasyn

Answer 5

1-2 g IV q 4-6 hours

CrCl 15-29, give q 12 hours

CrCl <14, give q 24 hours

Question 6

Nafcillin

Answer 6

1-2 g IV q 4-6 hours

Reduce by 50% if severe hepatic impairment

Can cause bone marrow suppression over long term

Question 7

Zosyn

Answer 7

3.375 g q 6hrs or 4.5 g q 6-8 hours

CrCl 20-40, 2.25 g q 6 hours

CrCl <20, 2.25g q 8 hours

Question 8

Daptomycin

Answer 8

4-6 mg/kg q 24 hours

CrCl <30 use extended dosing q 48 hours

Question 9

Meropenem

Answer 9

500-1000mg q 8 hours

CrCl 26-50 give q 12 hours

CrCl 10-25, give 1/2 dose q 12 hours

CrCl < 10, give 1/2 dose q 24 hours

Question 10

Ertapenem

Answer 10

1000 mg daily

CrCl <30, 500 mg q 24 hours