Medications Approved for Automatic Therapeutic Interchange Dosage Conversion Guidelines (Note: “Therapeutic Interchange” should be placed in the order comments
Cephalosporins
Medication Ordered
Brand Name
Ordered Dosage
Frequency
Formulary Medication
Equivalent Dose
Frequency
Cefotaxime
Claforan
1gm
q8h or q12h
Ceftriaxone
1gm
q24h
2gm
q8h or q12h
2gm
q24h
1gm
q4h or q6h
1gm
q12h
2gm
q4h or q6h
2gm
q12h
Creatinine Clearance
< 10 ml/min
Call MD with Recommendation based on diagnosis (see lexicomp)
Ceftazidime
Fortaz
1gm
q8h
Cefepime
1gm
q12h
2gm
q8h
2gm
q12h
1gm
q12h
1gm
Q24h
Creatinine Clearance
< 60 ml/min
Call MD with Recommendation based on diagnosis (see lexicomp)
Exceptions: These agents are approved for use in pediatric patients
Antibiotic
Usual Dose
Renal Adjustment
HD
CAPD
CRRT: Consult Pharmacy Clinical Specialist for Dose Determination
Ceftazidime
Severe infections:
Febrile neutropenia, critically ill, meningitis, pseudomonas,CF, endocarditis, PNA
1 g q8h
Severe infections:
2 g IV q8h
CrCl 31-50: 1 g q12h
CrCl 16-30: 1 g q24h
CrCl <10: 500mg q24h
Severe infections:
CrCl 31-50: 2 g q12h
CrCl 16-30: 2 g q24h
CrCl <16: 1 g q24h
500 mg q24h
Severe infections:
1 g q24h
(Dose after HD on HD days)
1 g q24h
2 g q12h
Medications Approved for Automatic Therapeutic Interchange Dosage Conversion Guidelines
(Note: “Therapeutic Interchange” should be placed in the order comments
Cephalosporins
Medication Ordered
Brand Name
Ordered Dosage
Frequency
Formulary Medication
Equivalent Dose
Frequency
Cefotaxime
Claforan
1gm
q8h or q12h
Ceftriaxone
1gm
q24h
2gm
q8h or q12h
2gm
q24h
1gm
q4h or q6h
1gm
q12h
2gm
q4h or q6h
2gm
q12h
Creatinine Clearance
< 10 ml/min
Call MD with Recommendation based on diagnosis (see lexicomp)
Ceftazidime
Fortaz
1gm
q8h
Cefepime
1gm
q12h
2gm
q8h
2gm
q12h
1gm
q12h
1gm
Q24h
Creatinine Clearance
< 60 ml/min
Call MD with Recommendation based on diagnosis (see lexicomp)
Exceptions: These agents are approved for use in pediatric patients