Disclaimers
Recommendations on this page have been developed in collaboration with the Sinai Health Antimicrobial Stewardship Program.
This page is intended to provide recommendations that we expect to be appropriate for the majority of patients in a given clinical scenario, however may not encompass all scenarios. Clinical judgment is required when applying recommendations to an individual patient.
While we have attempted to incorporate available literature into recommendations wherever possible, some recommendations are based solely on expert opinion and local practice at University Health Network and/or Sinai Health System. Caution is advised when applying recommendations to patient populations at other institutions.
There are several equations used to estimate renal function, most commonly, the Cockroft-Gault equation to calculate CrCl and the CKD-Epi 2021 equation to calculate eGFR. For the purpose of this page, we have elected to report recommendations based on CrCl, acknowledging that CrCl may not be the best marker of renal function in all patients. This may be updated in the future, as more experience/literature becomes available to inform drug dosing recommendations based on eGFR.
Recommendations were designed primarily for use in inpatient settings, where frequent monitoring is possible. Clinical judgement is required when extrapolating to ambulatory care or outpatient settings.
Scope
- Adult patients only
- Intravenous and oral/enteral routes of therapy only
- Dosage adjustments in the setting of renal impairment and renal replacement therapy
Recommendations DO NOT take into account the following factors
Additional dosage adjustments may be required in these scenarios:
- Drug interactions
- Hepatic impairment
- Extremes of body weight (i.e. obesity)
- Cystic fibrosis
- Extracorporeal membrane oxygenation (ECMO)
- Plasma exchange (PLEX)
