Antibiotics and Kidney Disease

Surgical patients with renal disease offer special challenges to the treating doctor.  Antibiotic coverage during the perioperative period if merited should be carefully chosen.  These general guidelines listed  are no substitute for a nephrology consultation prior to surgery.  The renal specialist plays an important role in medication choice and dosage.

SAFE ANTIBIOTICS
Clindamycin: No dose change
Azithromycin: No dose change
Doxycycline: No dose change
Metronidazole: Normal dose for Mild/Mod. disease
Vancomycin Pulvules

ANTIBIOTICS WITH ALERTS
Pen VK: Prolong interval
Amoxicillin: Prolong interval
Augmentin: Decrease dose
Ampicillin: Decrease dose
Dicloxacillin: Decrease dose
Keflex: Prolong interval
Duricef: Prolong interval
Clarithromycin: Avoid
Metronidazole: Prolong interval for severe disease
IV Vancomycin: Avoid
1)Pen VK: INTERVAL PROLONGED; DOSE UNCHANGED

a)Serum Creatinine < 2.0 mg/dL or the CrCl is > 50 mL/minute:
Pen VK is dosed normally at 250-500 mg PO q6h
b)S. Creatinine 2.0 mg/dL to Predialysis or CrCl 10-50 mL/minute:
Pen VK is dosed at 250-500 mg q8-12h
c)Patient on Dialysis:
Pen VK is dosed at 250-500 q12-16h

2)Amoxicillin: DOSE UNCHANGED; INTERVAL PROLONGED

a)Serum Creatinine below 3.3 mg/dL or Cr Cl >30 ml/minute:
Dispense the normal dose of Amoxicillin: 250-500 mg PO q8h
b)Serum Creatinine above 3.3 mg/dL to Predialysis or Cr Cl 10-30 ml/minute:
Prolong the interval and dispense: 250-500 mg PO q12h
Avoid using the 875 mg tablet
c)Cr Cl <10 ml/minute or the Dialysis Patient:
Prolong the interval and dispense: 250-500 mg PO q24h
The dose must be administered after dialysis completion

3)Augmentin:
Decrease the total dosage by 50% in the renal compromised patient

4)Azithromycin:
Use full dose of Azithromycin in the Renal compromised patient
Kidney disease: No dose change is needed with Kidney disease or Renal failure
Used with 50% total dose reduction in patient with both Kidney & Liver disease

5)Metronidazole (Flagyl):
Dose adjustment is required only in the presence of renal failure/dialysis
Metronidazole should be dosed at 500 mg PO q12h instead of q8h after the dialysis

6)Tetracycline HCL:
a. Serum Creatinine between 1.25-2.0 mg/dL or CrCl 50-80 mL/minute:
Dose Tetracycline HCL q8-12h
b. Serum Creatinine between 2.0 mg/dL to Pre-dialysis or CrCl 10-50 mL/minute:
Dose Tetracycline HCL q12-24h
c. In the presence of Dialysis or CrCl <10 mL/minute:
Dose Tetracycline HCL q24h

7)Doxycycline:
No dose change needed with kidney/live/kidney & liver disease

The Palm Beach Center for Oral Surgery and Dental Implants providing quality care to Delray Beach, Boca Raton, Boynton Beach, and  Palm Beach County.  561.900.9080 www.PasqualOMS.com

The Palm Beach Center for Oral Surgery and Dental Implants providing
quality care to Delray Beach, Boca Raton, Boynton Beach, and Palm Beach County.

561.900.9080 | www.PasqualOMS.com