In the setting of rapidly improving/worsening renal function, calculations of eGFR are inaccurate, and dosing should be based on estimated renal function instead.
If worsening renal function, actual GFR is likely lower than calculated.
If improving renal function, actual GFR is likely higher than calculated eGFR.
0 - 30 eGFR
100-200mg IV/PO q24h (higher doses may be required for severe infections)
30 - 50 eGFR
100-200mg IV/PO q24h (400mg IV/PO q24h for invasive infections)
50+ eGFR
100-400mg IV/PO q24h
Give full dose by indication after each HD session
Invasive infection: 600mg IV q24h
Esophageal infection: 200mg IV/PO q24h
