Spectrum: Local Antimicrobial Stewardship, for Markham Stouffville Hospital

Acyclovir Dose Adjustment

Note

Dosage guidelines apply to all neonates until a PMA greater than 44 weeks and a PNA of greater than 4 weeks unless otherwise stated

Renal Impairment

Moderate (GFR=25-50 mL/min)
  • q12h

Severe (GFR=10-25 mL/min)
  • q24h

Failure (GFR <10 mL/min)

  • 50% of dose q24-48h.

  • Start with q24h and adjust to q48h as needed, in consultation with pharmacy.

Hemodialysis

  • 50% of dose q24h

  • Give after dialysis

Body Weight and Postmenstrual Age

  • Body Weight Less Than 1200g
  • PMA Less Than or Equal To 32 weeks

  • 20 mg/kg/dose q12h

  • In consultation with ID

  • Body weight Greater Than or Equal to 1200g
  • PMA Greater Than 32 weeks
  • 20mg/kg/dose IV Q8H