PENICILINAS, MONOBACTAMAS Y CARBAPENEMAS |
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Cl Cr ml/min | |||
---|---|---|---|
FÁRMACO | >30 | 30-10 | <10 |
Penicilina G Sódica | 1-3 UM/2-6h | 1-3 UM/8h | 1-2 MU/12h |
Ampicilina/Sulbactam | 1-2g Ampicilina/6h | 1-2g Ampicilina/12h | 1g Ampicilina/12h |
Amoxicilina | 100-300 mg/kg/dia | 500 mg/12h | 500 mg/dia |
Amoxicilina/Clavulánico | Sin cambios | 500/125 mg oral/12h
500/100 mg iv/12h |
500/125 mg oral/24h
500/100 mg iv/24h |
Cloxacilina | 0.5-1g/4-6h | 0.5-1g/4-6h | 0.5-1g/4-6h |
Piperacilina/Tazobactam | 4g Piperacilina/6-8h | 3g Piperacilina/8h | 2g Piperacilina/6-8h |
Aztreonam | 1-2g/6-8h | 0.5-1g/8-12h | 500g/8-12h |
Ertapenem | 1g/24h | 500 mg/24h | 500 mg/24h |
Imipenem | FG 80-50: 500 mg/6h | FG 50-20: 500 mg/8h | FG <20: 500 mg/12h |
Meropenem | FG 50-25: 1g/8h | FG 25-10: 1g/8-12h | 1-2g/24h |
Meropenem/Vaborbactam | FG 20-39 1g/1g cada 8h | FG 10-19 1g/1g cada 12h | FG<10 0,5 g/0,5 g cada 12h |
CEFALOSPORINAS |
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Cl Cr ml/min | |||
---|---|---|---|
FÁRMACO | >30 | 30-10 | <10 |
Cefazolina | FG: 50-10: 0.5-1g/8-12h | FG: 50-10: 0.5-1g/8-12h | 0.5-1g/24h |
Cefuroxima, Cefuroxima Axetilo | 750-1500 mg/8h I.V Oral sin cambios |
750mg/12h I.V
Oral sin cambios |
750 mg/24h I.V
500 mg/24h Oral |
Ceftriaxona | 1-2g/12-24h | 1-2g/12-24h | 1g/24h |
Cefotaxima | 1-2g/6-8h | FG 50-10: 1-2g/8h | 1g/12h |
Ceftazidima | FG 50-30: 1g/12h | 1g/24h | 1g/24-48h |
Cefepime | 1-2 g/8-12h | 1-2 g/24h | 0.5-1 g/24h |
Ceftazidima/Avibactam | FG 50-30: 1g/0,25 cada 8h | FG 16-30:0,75g/0,185 cada 12 | FG 6-15 :0,75g/0,185 cada 24 IR terminal incluido HD :0,75g/0,185 cada 48h |
AMINOGLUCÓSIDOS |
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Cl Cr ml/min | |||
---|---|---|---|
FÁRMACO | >30 | 30-10 | <10 |
Gentamicina | FG 60-40: 5 mg/kg/36h | FG 40-20:5mg/kg/48h | FG <20: 2mg/kg/48h |
Tobramicina | |||
Amikacina | FG 60-30: 15 mg/kg/dia | 10 mg/kg/24h | 10mg/kg/48h |
FLUORQUINOLONAS |
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Cl Cr ml/min | |||
---|---|---|---|
FÁRMACO | >30 | 30-10 | <10 |
Ciprofloxacino | 250-750/12 oral
400 mg/8-12h iv |
500 mg/24h oral
200 mg/12h iv |
500 mg/24h oral
200 mg/12h iv |
Levofloxacino | FG 50-20: 250 mg/24h | FG<20: 250 mg/48h | 250 mg/48h |
Norfloxacino | 400 mg/12h | 400 mg/12h | 400 mg/24h |
TETRACICLINAS |
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Cl Cr ml/min | |||
---|---|---|---|
FÁRMACO | >30 | 30-10 | <10 |
Doxicilina | 100 mg/12-24h | 200 mg/24h | 200mg/24h |
Tigeciclina | - | - | - |
GLUCOPÉPTIDOS |
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Cl Cr ml/min | |||
---|---|---|---|
FÁRMACO | >30 | 30-10 | <10 |
Vancomicina | FG < 80: MEDIR NIVELES PLASMÁTICOS EN EL VALLE | ||
Teicoplanina | FG 40-60: dosis normal primeros 4 dias, luego 3 mg/kg/dia o 6 mg/kg/48h | FG <40: dosis normal primeros 4 dias, luego 2 mg/kg/dia o 6 mg/kg/72h | FG <40: dosis normal primeros 4 dias, luego 2 mg/kg/dia o 6 mg/kg/72h |
OTROS |
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Cl Cr ml/min | |||
---|---|---|---|
FÁRMACO | >30 | 30-10 | <10 |
Claritromicina | VO 250-500 mg/12h o 1g/24h formulación retard IV 500 mg/12h | 500 mg/24h | 500 mg/24h |
Cotrimoxazol | 160/800 mg 8-12h | 160/800 mg 24h | 80/400 mg/24 h Evitar |
Clindamicina | - | - | - |
Colistina | FG 50-30:1-2 MU/12h | 1MU/24h | 1MU/24-48h |
Metronidazol | - | - | 250 mg/8h |
Fosfomicina | IV FG 40-20: 4g/12h | IV FG 20-10: 4g/24h | IV FG<10: 2g/24h |
Linezolid | -- | - | |
Daptomicina | 6-10 mg/kg/24h | 4-6 mg/kg/48h | 4-6 mg/kg/48h |