By John G. Bartlett
Designed to supply easy accessibility to the factors with which to struggle infectious sickness by means of concentrating on choice, right doses, bills, and unintended effects of antimicrobial brokers, the 2004 notebook of Infectious disorder treatment attracts widely from strategies made by way of the facilities for affliction regulate, the scientific Letter, the yankee clinic Formulary carrier, and the AMA's Drug reviews. Tabular fabric has been up to date to incorporate all newly authorized antibiotics, in addition to new techniques for administration.
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Adjustments in subsequent doses for renally excreted drugs may be accomplished by a) giving the usual maintenance dose at extended intervals, usually three half-lives (extended interval method); b) giving reduced doses at the usual intervals (dose reduction method); or c) a combination of each. 85 Pitfalls and notations with calculations follow. a. Elderly patient: Serum creatinine may be deceptively low (with danger of overdosing) because of reduced muscle mass. b. Pregnancy, ascites, and other causes of volume expansion: GFR may be increased (with danger of underdosing) in third trimester of pregnancy and patients with normal renal function who receive massive parenteral fluids.
Rimantadine: Severe hepatitis disease use 100 mg/d (half dose). Telithromycin: No dose adjustment. Ticarcillin: For patients with hepatic dysfunction and creatinine clearance <10 mL/min, give 2 g/d IV in one or two doses. 1 g) followed by 2 g once daily. Trovafloxacin: For hepatic failure, adjust by indicated dose—indicated dose 300 mg/d IV, use 200 mg/d; indicated dose 200 mg/d IV or po, use 100 mg/d; indicated dose 100 mg/d, use 100 mg/d. Voriconazole: Mild to moderate hepatic insufficiency—6 mg/kg IV q12h × 2, then 2 mg/kg IV q12h.
B. Pregnancy, ascites, and other causes of volume expansion: GFR may be increased (with danger of underdosing) in third trimester of pregnancy and patients with normal renal function who receive massive parenteral fluids. c. Obese patients: Use lean body weight. d. Renal failure: Formulas assume stable renal function; for patients with anuria or oliguria assume creatine clearance (CCr) of 5–8 mL/min. B. AMINOGLYCOSIDE DOSING 1. 12 × CCr = mg/kg/8 h 20–40 Cg/mL a Doses for gentamicin and tobramycin should be written in multiples of 5 mg; doses of amikacin and kanamycin should be written in multiples of 25 mg.