Slow IV infusion over 30-60 min. Adult & adolescent Critically ill Loading dose: 9 million IU. Maintenance dose: 9 million IU daily in 2-3 divided doses. Adult 125,000 IU intrathecally daily. Childn ≤40 kg 75,000-150,000 IU/kg daily divided into 3 doses. >40 kg Adult dose. Renal impairment CrCl <50-30 mL/min 5.5-7.5 million IU daily, CrCl <30-10 mL/min 4.5-5.5 million IU daily, CrCl <10 mL/min 3.5 million IU daily. Haemodialysis (HD) Non-HD days: 2.25 million IU daily (2.2-2.3 million IU daily). HD days: 3 million IU daily to be given after HD. Conventional haemodialysis & continuous venovenous haemo(dia)filtration (CVVHF/CVVHDF) Tid.
Patients w/ porphyria; myasthenia gravis. Discontinue treatment in case of allergic reaction; if C. difficile-associated diarrhea is suspected or confirmed. Not to be given w/ medicinal products that inhibit peristalsis. Consider co-administration w/ other antibiotic in order to prevent emergence of resistance. Increased risk of nephrotoxicity in patients who are hypovolaemic or taking other potentially nephrotoxic drugs. Monitor renal function at the start & regularly during treatment. Observe signs of overdosage eg, perioral paraesthesia & paraesthesia in the extremities. Resp arrest following IM administration. Hepatic impairment. Pregnancy & lactation. Older patients. Infants <1 yr.
Concomitant use w/ other medications that are potentially nephrotoxic or neurotoxic; drugs known to inhibit or induce drug metabolising enzymes or to be substrates for renal carrier mechanisms. Prolonged effects w/ non-depolarising muscle relaxants. Co-treatment w/ macrolides eg, azithromycin & clarithromycin, or fluoroquinolones eg, norfloxacin & ciprofloxacin in patients w/ myasthenia gravis.
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