13
Children Reduced Renal Function
a
≥ 35 kg : adult dose
≥ 6 years and 20–34 kg :
50 mg 2× a day
>3–5 years and 10–20 kg :
25 mg 2× a day
Lower age/weight:
studies ongoing
Mild-moderate renal
insufficiency – no change.
Severe insufficiency –
limited data, use with
caution
20–25 mg/kg/day 3×/wk
30–40 mg/kg/day 3×/wk
15–20 mg/kg total (divided 1–2 times daily) No change needed
15–20 mg/kg total (divided 1–2 times daily) No change needed
(imipenem component) 15–25 mg/kg/dose 4× a day May reduce frequency
20–40 mg/kg/dose 3× a day May reduce frequency
25 mg/kg/dose of amoxicillin component 3 ×/day May reduce frequency to
match carbapenem
200–300 mg/kg/day in two divided doses
j
No change needed
15–20 mg/kg/day No change needed
g
Ethionamide can be given at bedtime or with a meal to reduce nausea. Experienced
clinicians suggest starting with 250 mg once daily and gradually increasing the dose over
1 week. Serum concentrations may be useful in determining the appropriate dose. Few
patients tolerate 500 mg twice daily.
h
Studies are ongoing evaluating meropenem at higher doses (ClinicalTrials.gov identifiers:
NCT03174184 and NCT02349841).
i
Some experts prescribe p-aminosalicylic acid at 6 g, and up to12 g, administered once daily.
j
For children, some experts prescribe p-aminosalicylic acid at 200 mg/kg administered once
daily.
k
Isoniazid is tested at two concentrations. Some experts use these results (or resistance
conferred through mutations in inhA) to select a higher dose when it tests resistant at the
lower concentration and susceptible at the higher concentration. e higher dose may
achieve in vivo concentrations sufficiently high to overcome low-level resistance.
