23
Table 11. Dosing Recommendations for Adult Patients With
Reduced Renal Function
a
Drug
Change in
Frequency?
Recommended Dose and Frequency for Patients
With Creatinine Clearance <30 mL/min, or
Patients Receiving Hemodialysis
Isoniazid
No 300 mg once daily, or 900 mg 3 times/wk
Rifampin
No 600 mg once daily, or 600 mg 3 times/wk
Pyrazinamide
Yes 25–35 mg/kg/dose 3 times/wk (not daily)
Ethambutol
Yes 20–25 mg/kg/dose 3 times/wk (not daily)
Levofloxacin
Yes 750–1000 mg/dose 3 times/wk (not daily)
Moxifloxacin
No 400 mg once daily
Cycloserine
Yes 250 mg once daily, or 500 mg/dose 3 times/wk
b
Ethionamide
No 250–500 mg/dose daily
Para-amino
salicylic acid
No 4 g/dose twice daily
Streptomycin
Yes 15 mg/kg/dose 2–3 times/wk (not daily)
Capreomycin
Yes
Kanamycin
Yes
Amikacin
Yes
• Standard doses are given unless there is intolerance.
• The medications should be given after hemodialysis on the day of hemodialysis.
• Monitoring of serum drug concentrations should be considered to ensure adequate
drug absorption, without excessive accumulation, and to assist in avoiding toxicity.
• Data currently are not available for patients receiving peritoneal dialysis. Until data
become available, begin with doses recommended for patients receiving hemodialysis
and verify adequacy of dosing using serum concentration monitoring.
• In patients with 30–50 mL/min creatinine clearance, standard doses are used
by experts, but measurement of serum concentrations 2 and 6 hours after timed
administration can be used to assist with optimizing drug dosages.
a
Including adult patients receiving hemodialysis.
b
e appropriateness of 250-mg daily doses has not been established. ere should be careful
monitoring for evidence of neurotoxicity.