≥50 ml/min 15-20 mg/kg IV Q12h* 20-49 ml/min 15-20 mg/kg IV Q24h <20 ml/min 15-20 mg/kg IV Q48h or dose by level Intermittent hemodialysis 15 mg/kg post HD *Consider Q8h if patient <50 years old and CrCl>100 ml/min Notes Avoid every 18 hour and every 36 hour …
