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Dosing recommendations are based on creatinine clearance calculated using the Cockcroft-Gault equation.
Do not use eGFR estimates (available on PAS) for drug dosing purposes (for more information click here )
To calculate creatinine clearance (CrCl) using the Cockcroft-Gault equation,
use the creatinine clearance calculator :
Many elderly patients have a degree of renal impairment, which, because of reduced muscle mass, may not be indicated by a raised serum creatinine level. It is therefore important to calculate the CrCl for this patient group. Anuric and oliguric (<500ml/day) patients can be assumed to have a CrCl < 10ml/min (severe renal impairment).
Accurate estimation of CrCl is only possible in patients with STABLE renal function. In patients with rapidly changing renal function (i.e. ACUTE renal failure), the serum creatinine levels will no longer provide a true reflection of renal function.
Dose adjustment may not be appropriate in ACUTE renal impairment secondary to SEPSIS. In this case it is important to treat the infection aggressively for the first 24hrs and re-check renal function before reducing the dose accordingly.
(In 'acute on chronic' renal impairment the initial dose should correspond to the previous level of chronic renal impairment).
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Amoxicillin (IV Ampicillin no longer available at GHNHSFT)
Amphotericin - (Fungizone® and Ambisome®)
Sodium fusidate (Fusidic acid)
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