Attention: This is an archive version of the HELP CDSS for documentation purposes. It is neither updated nor actively maintained!
| GFR>50 | GFR 30-50 | GFR <30 | CHD | CVVH | |
| Cefazolin | 3-4 x 2g | 3 x 1 g | 2 x 1 g | 1 g pHD | 2 x 2 g |
| Flucloxacillin | 6 x 2 g / 4x 3 g | 3 x 3 g | 3 x 1-2 g | 3 x 1 g | 3 x 4 g |
| Daptomycin | Use of the ideal body weight | ||||
| 1 x 10-12 mg/kg | 1 x 8-10 mg/kg | 1 x 8-10 mg/kg q48h | 1 x 8-10 mg/kg pHD | 1 x 8-10 mg/kg q48h | |
| Vancomycin |
Loading dose
25-30 mg/kg body weight (use of actual body weight)
Target level 15–20 mg/l or with continuous infusion 20-25 mg/l Blood sampling for therapeutic drug monitoring before next administration or before dialysis |
||||
| Maintenance dose depending on trough level 15-20 mg/kg every 8-12h or as a continuous infusion | 1g pHD TDM | TDM | |||
| Fosfomycin | 3 x 5(-8*) g | 3 x 3-5 g | 2-3 x 2 g | 4 g pHD | 3 x 5 g (up to 8 g) |
| Cefalexin | 3-4 x 1 g | 3 x 0.5-1 g | 2-3 x 500 mg | 2 x 0.5-1 g | 3-4 x 1 g |
| Linezolid p. o. | 2 x 600 mg | ||||
| Cotrimoxazole p. o. | 2-3 x 960 mg | 2 x 960 mg | 2 x 480 mg | 1 x 480 mg | 3 x 960 mg |
| Rifampicin p. o. | 1 x 10 mg/kg distributed over 1-2 doses | ||||
| Levofloxacin p.o. | 1-2 x 500 mg | 1-2 x 250 mg | 1-2 x 0.125 mg | 1 x 0.125 mg | 1-2 x 500 mg |
| Doxycycline p. o. | 1 x 200 mg | ||||
| *for meningitis and life-threatening infections |
Abbreviations:
| CHD | Chronic hemodialysis |
| CVVH | Continuous venovenous hemofiltration |
| pHD | after dialysis |
| q48h | every 48 hours |
| TDM | Therapeutic drug monitoring |