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About

Antibiotic stewardship requires not just selecting the right drug, but the right dose. A significant percentage of adverse drug events are caused by failure to adjust dosages for renal function. Accumulation of antibiotics like Ciprofloxacin or Vancomycin in patients with reduced Creatinine Clearance (CrCl) can lead to nephrotoxicity or neurotoxicity. This calculator serves as a rapid decision support tool for primary care.

The system integrates standard dosing regimens with a binary "Kidney Check" logic. While full nephrology consults use exact CrCl numbers, this tool allows a quick toggle for 'Impaired (<30 mL/min)' to instantly suggest the guideline-recommended dose reduction or interval extension, acting as a critical safety barrier in fast-paced clinical environments.

antibiotics renal dose CrCl medical calc infectious disease

Formulas

The calculator applies a logic gate based on the renal flag.

IF Renal_Impairment == TRUE CrCl < 30 mL/min

{
Reduce Dose by 50%OR Extend Interval (q12h q24h)

Drugs with hepatic metabolism (e.g., Azithromycin) return NULL adjustment.

Reference Data

AntibioticStandard DoseRenal Adjust (CrCl < 30)Common Usage
Amoxicillin500 mg q8h250-500 mg q12hRTI, ENT
Ciprofloxacin500 mg q12h500 mg q24hUTI
Levofloxacin500-750 mg q24h750 mg q48hPneumonia
Cephalexin500 mg q6h500 mg q12-24hSkin/Soft Tissue
Nitrofurantoin100 mg q12hCONTRAINDICATEDUTI (Lower)
Azithromycin500 mg DailyNo AdjustmentAtypical Pneumonia
Doxycycline100 mg q12hNo AdjustmentTick-borne, Acne
Clindamycin300 mg q6-8hNo AdjustmentDental, Skin

Frequently Asked Questions

This tool uses a conservative threshold of CrCl < 30 mL/min for its "Renal Impairment" toggle. This covers CKD Stages 4 and 5, where accumulation risks are highest.
No. Vancomycin requires complex pharmacokinetic monitoring (AUC/MIC) and serum level testing. This tool is for fixed-dose oral antibiotics commonly used in outpatient settings.
Doxycycline is excreted primarily via feces (bile/intestinal), not the kidneys. Therefore, it is safe to use at standard doses even in patients with renal failure.