Antibiotic Mixing Chart

Drug and Diluent Compatibl Recommended administration Solubility Special precautions

available (concentration) e vehicle
strengths for
infusion
Acyclovir (Antiviral agent)
Zovirax® 250mg + 10ml WFI N/S IV infusion: Diluted: - Infusion concentrations lower than 7mg/ml are recommended to
250mg/vial or N/S (25mg/ml) Dilute to a concentration not RT: 12 hours reduce phlebitis.
(as freeze-dried greater than 5mg/ml: Do not refrigerate - Pre-hydrate patient to prevent crystallization of drug in renal
sodium salt) : 250-500mg in 100ml over 1 hour tubules.
: 500-1000mg in 200ml over 1hour - Monitor renal function with IV acyclovir use.
Aspen Acyclovir® - HSV encephalitis: IV infusion over 1 hour, 10 mg/kg 8 hourly for
250mg/vial 14–21 days.
(powder for - Disseminated HSV or severe primary HSV: IV infusion over 1 hour,
solution for 5 mg/kg 8 hourly for 10 days.
infusion) - Severe varicella-zoster infections: IV infusion over 1 hour,
10 mg/kg 8 hourly for 7 days.
- RENAL: GFR 10-50ml/min – 100% dose 12-24 hrly
GFR < 10ml/min – 50% dose 24 hrly
Amikacin (Aminoglycoside)
Amikacin- In solution N/S IV infusion: Discard unused portion - Solution may darken from colourless to pale yellow. This does
Fresenius® (250mg/ml) D/W 5% Dilute in 100-200mls over 30-60 NOT indicate a loss of potency.
500mg/2ml minutes - Target plasma levels: Once daily dosing: Peak >30mg/L;
1g/4ml Trough < 1mg/L
IV Bolus: - IM or slow IV over 30 minutes, diluted in 5% dextrose or 0.9%
Slowly over 2-3 minutes sodium chloride solution, 15 mg/kg/day as a single daily dose.
Maximum 1.5 g/day.
IM - TB, in combination with other antituberculosis agents: 15–20
mg/kg once daily (as part of a salvage regimen only).
- RENAL FAILURE (GFR < 60ml/min): 10mg/kg loading dose; further
doses according to plasma levels
Amoxycillin/Clavulanic acid (Penicillin and Β-lactamase Inhibitor)
Sandoz Co- 0.6g + 10ml WFI N/S IV infusion: Reconstituted: - Not IM or S/C
Amoxyclav® 1.2g + 20ml WFI Ringers Dilute in 100ml over 30 minutes RT: 20 minutes - IV, injection over 2 minutes or infusion over 30 minutes,
0.6g (60mg/ml) lactate FT: must dilute before 1.2 g 6–8 hourly
(500/100mg/vial) IV Bolus: refrigeration - Clavulanic acid dose should not exceed 800mg/day.
1.2g Slowly over 2 minutes - Note: Clavulanic acid degrades rapidly after mixing the parenteral
(1000/200mg/vial) Diluted: within 20 formulation, which must be given within 30 minutes of mixing.
minutes of recon. - RENAL: GFR 10-30ml/min – bd
RT: 4 hours3 GFR < 10ml/min – od
FT: 8 hours3
Ampicillin (Β-lactamase sensitive penicillin with extended spectrum)
Ampicillin- IV: N/S IV infusion: Diluted: - Protect from light
Fresenius® 500mg + 10ml WFI D/W 5% Dilute in 50-100ml over 15-30 RT: N/S – 6-8 hours - Anaphylactic reactions can occur with IV use
Ampicillin Unimed® (50mg/ml) D/saline minutes1 : D/W 5% - 1 hour - Cerebral irritation with convulsions can develop, rarely, when high
Auro ampicillin® Ringers : D/saline – 1 hour doses are given IV
500mg/vial IM: IV Bolus: : Ringers – 6-8 hours - IV ampicillin should not be mixed in same infusion container as
500mg + 2ml WFI Slowly over 3-5 minutes IM or Bolus: any other drug
(250mg/ml) Administer stat and - IM, 500 mg 6 hourly. IV, by slow injection or infusion over 30–60
IM discard unused portion minutes, 1 g 4–6 hourly (up to 12 g daily for severe infections).
- Meningitis: IV, 1–2 g 3–4 hourly; maximum 300 mg/kg/day or 16 g
- RENAL: GFR 10-50ml/min – 6-12 hourly
GFR <10ml/min – 12-24 hourly
Amphotericin B (Antifungal)
Fungizone® 50mg + 10ml WFI D/S 5% IV infusion: Powder form should - Aseptic technique should be observed during preparation since no
50mg/vial (5mg/ml) ONLY Dilute to a concentration of be stored in the fridge preservative is present.
0.1mg/ml or less and protected from - N/S may cause precipitation of the antifungal solution
: In 1L D/W 5% over 4 hours light till ready to use. - Frequent monitoring of kidney function, K+ and Mg2+ is indicated
in all patients; some authorities recommend temporary
Reconstituted and discontinuation of therapy if kidney function becomes severely
diluted: impaired; alternate-day therapy (not exceeding 1.5 mg/kg) may be
Use promptly and considered.
discard unused - IV infusion should be slow (over 4 hours). Continuous infusion
portion. over 24 hours is associated with less nephrotoxicity, but is not
recommended as efficacy may be compromised
- Max.: daily dose must NOT exceed 1.5mg/kg
- RENAL: GFR <10ml/min – extended dose interval of 36hr
NOT removed by haemodialysis
Azithromycin (Macrolide)
Cipla 500mg + 4.8ml WFI N/S IV infusion: Reconstituted:
Azithromycin® (100mg/ml) D/W 5% Dilute in 250ml over 60 minutes OR RT: 24 hours
500mg/vial Ringers Dilute in 500ml over 3 hours
(powder for lactate
infusion) Not for bolus or IM injection

Benzathine benzylpenicillin (Β-lactamase sensitive penicillin)

Penilenta LA® 1.2MU + 3.5ml WFI IM injection only Reconstituted: - IM ONLY
NCPC Benzathine (1.2MU/4ml)2, Use immediately - Note: 600 000 units equivalent to 450mg
Penicillin® Penilente LA

1.2 MU/vial
2.4 MU/vial 2.4MU + 7ml WFI
(2.4MU/8ml)2,
Penilente LA
Benzylpenicillin sodium (Β-lactamase sensitive penicillin)
Bio-Pen® 1MU + 4.6ml WFI N/S3,4 IV infusion: (doses > 2MU) Bio-Pen Reconstituted: - Note: 1 000 000 units (1MU) equivalent to 600mg
NCPC® (1MU/5ml) 2, Bio-Pen
D/W 5%3,4 Infuse at max. rate of 500 000 RT: 2 days - IM is painful so IV preferred
1MU (600mg)/vial units/min FT: 7 days Bio-Pen - The IV dose should be diluted in fluid with pH 6–7.2, e.g.
5MU (3g)/vial 5MU + 7.8ml WFI Dilute in 50ml over 30 minutes 2,4 5% glucose or 0.9% sodium chloride solution.
(5MU/10ml) 2, Bio-Pen - RENAL: GFR 10-50ml/min – 75% of dose;
= 1MU/2ml IV Bolus: (doses ≤ 2MU) Bio-Pen GFR <10ml/min – 25-50% of dose
Slowly over 3-5 minutes Anuric patients should not receive > 3MU/day

IM: (doses ≤ 2MU) Bio-Pen

Cefazolin (First-generation cephalosporins)
Zefkol® IV: N/S IV infusion: Reconstituted: - Solution is colourless to light yellow
1g/vial 1g + 10ml WFI D/W 5% : <1g in 50ml over 30 minutes 4 RT: 24 hours - Max.: 6g/day (in severe infections up to 12g/day)
(100mg/ml) D/W 10% : >1g in 100ml over 30 minutes 4 FT: 10 days - Surgical prophylaxis: 1g 30-60 minutes before incision, repeated 4
D/saline IV Bolus: hourly during prolonged surgery.
IM: Ringers Slowly over 3-5 minutes Diluted: - RENAL: GFR 10-50ml/min – 100% of dose bd
1g + 3ml WFI lactate RT: 24 hours GFR <10ml/min – 50% of dose 24-48 hrly
(285mg/ml) IM FT: 96 hours
Cefepime (Fourth-generation cephalosporins)
Auro Cefepime® IV: N/S Infusion: Diluted: to a conc. of - Synergistic in combination with aminoglycosides
1g/vial 1g + 10ml WFI D/W 5% Dilute in 50-100ml over 30 minutes 1-40mg/ml - Nonconvulsive status epilepticus has been reported in patients
2g/vial (90mg/ml) D/W 10% RT: 24 hours with renal impairment. Cefepime therapy should be discontinued
2g + 10ml WFI D/saline IV Bolus: FT: 7 days or dose adjusted appropriately
(160mg/ml) Ringers Slowly over 3-5 minutes - IV or IM, usually 1 g 8–12 hourly.
lactate IM: - UTI (mild to moderate): IV or IM, 0.5–1 g 12 hourly.
IM: IM RT: 24 hours - Severe infections: IV, 2 g 12 hourly. Consider loading of 2 g and
1g + 3ml WFI or 1% FT: 7 days prolonged or continuous infusions in ICU patients.
lidocaine - P. aeruginosa infections: IV, 2 g 8–12 hourly.
(230mg/ml) - RENAL: GFR 10-60ml/min – 50 to 100% of dose 24hourly
GFR < 10ml/min – 25 to 50% 24hourly
Ceftazidime (Third-generation cephalosporins)
Fresenius 1g: N/S IV infusion: Reconstituted: - Vials are packed under reduced pressure. On addition of diluent,
Ceftazidime® IM: + 3ml 1% D/W 5%4 Dilute in 50mls over 30 minutes 1 RT: 24 hours Taziject CO2 is released creating a positive pressure in the vial. Allow 1-2
Taziject® lignocaine D/W 10% FT: 48 hours Teziject min to clear. To withdraw solution, air is not required in syringe.
1g/vial (260mg/ml) Ringers IV Bolus: Invert vial and insert needle ensuring it remains below the liquid
2g/vial IV: + 10ml WFI 3 lactate Slowly over 3-5 minutes 1 level. The positive pressure aids withdrawal. Expel bubbles. - -
(90mg/ml) - Solution is clear to pale yellow.
IM - IM or IV, 2–6 g daily in 2–3 divided doses.
2g: - P. aeruginosa: IV, 2 g eight hourly. Load with 2g and give continue
IV: + 10ml WFI 3 infusion in severe infections.
(170mg/ml) - Pseudomonal lung infection in cystic fibrosis: 100–150 mg/kg/day
in 3 divided doses; up to 9 g/day (normal kidney function).
- RENAL: GFR 10-50ml/min – 1 to 2g 12 to 24 hourly
 GFR < 10ml/min – 24 to 48 hourly
Ceftriaxone (Third-generation cephalosporins)
Austell- IV: N/S IV infusion: Reconstituted: - Do not add to solution containing calcium (Ringers).
Ceftriaxone® 1g + 10ml WFI D/W 5%1 Dilute to 10-40mg/ml over 30 RT: 6 hours - IM or slow IV, 1–2 g daily as a single or 2 divided doses.
1g (100mg/ml) minutes1 FT: 24 hours Meningitis: 2 g 12 hourly. IM injections >1 g should be divided
: 0-1g in 50ml between more than one site.
IM: : >1g in 100ml4 - Gonorrhoea: IM, 250 mg as a single dose.
1g + 3.5ml WFI or - Meningococcal prophylaxis: IM, 250 mg as a single dose.
1% lignocaine IV Bolus: - RENAL, no dosage adjustment is required if creatinine clearance >
Slowly over 2-4 minutes 5ml/min, provided that hepatic function is normal
- HEPATIC DISEASE, dosage reduction (50%) is only required in
IM: cirrhosis when serum albumin levels are low
Doses >1g per injection site not
recommended
Ciprofloxacin (Fluoroquinolones)
Orpic® In solution N/S IV infusion: Discard unused. - Protect form light until use
Spec-Topistin® (2mg/ml) D/W 5% Infuse at a concentration of 1- - Solution is colourless to light yellow
Ciprocina® D/S 10% 2mg/ml over 60 minutes Do not refrigerate. - Avoid alkalisation of urine – maintain adequate fluid intake
100mg/50ml Ringers - Stop tx if symptoms of tendonitis and tendon rupture occur and
200mg/100ml lactate they should avoid exercise or use of the affected area
400mg/200ml - 4–6 weeks tx req. in bone infections, chronic prostatitis and
invasive salmonellosis in patients living with HIV
- IV infusion over 60 minutes, 200–400 mg 8–12 hourly.
- RENAL: GFR 10-50ml/min – 50 to 75% if dose
GFR <10/min – 50% of dose
Clindamycin (Lincosamide)
Clindamycin- In solution N/S IV infusion: Diluted: - MUST BE DILUTED
Fresenius® (150mg/ml) Dilute each 300mg in 50ml RT: 24 hours - Discontinue therapy and investigate for C. difficile if significant
600mg/4ml (6mg/ml) over 10 min diarrhoea occurs.
: 600mg in 100ml over 20 minutes - IV or IM, usual dose 600mg 8 hourly. Max.: 4.8g/day
: 900mg in 150ml over 30 minutes - Always dilute before IV administration and give slowly over at
: 1200mg in 200ml over 45 minutes least 20 minutes; doses should not exceed 1200mg. Not more
than 600mg should be injected into a single IM injection site.
IM:
Single IM > 600mg not
recommended
Cloxacillin (Β-lactamase resistant penicillin)
Cloxacillin- IM: N/S IV infusion: Reconstituted: - Products contain the sodium salt of Cloxacillin: fluid retention or
Fresenius® 250mg + 1.5ml WFI D/W 5% Dilute in 50ml2 over 30-40 minutes3 RT: 24 hours3 hypernatremia may follow administration of large doses in
250mg/vial 500mg + 5ml WFI FT: 48 hours3 susceptible patients (e.g., cardiac or renal failure)
500mg/vial IV Bolus: - IV formulations should be administered over 2 minutes.
IV: Slowly over 2-4 minute3 Diluted: - Adult: IV; 1-3g 6 hourly, by slow injection or infusion
250mg + 2.5ml WFI RT:
(100mg/ml) IM : N/S – 24 hours
500mg + 10ml WFI
 (50mg/ml) : D/W 5% - 8 hours
Colistin (Polymyxins)
Colimycine® 1MU + 3 ml N/S N/S IV infusion: Reconstituted: - Monitor renal function regularly (nephrotoxic)
1MU = 80mg CMS : Loading dose in 100ml over 60 Controlled RT and FT: 7 - Last line for multidrug resistant infection with Gram neg. bacilli
(colistimethate minutes5 days3,4 - Recommended doses of colistin have been increased based on
sodium) = 34mg : Maintenance doses in 50-100ml recent research and may exceed the manufacturer’s
colistin base over 15-30 minutes5 Diluted: recommendations. No international consensus exists on the
RT: 24 hours 3 correct dose and dosing units are not standardised.
- RENAL: GFR > 30-60ml/min – 2.75-3.75MU bd
GFR 10-30ml/min – 2.25 -2.75 MU bd
GFR <10ml/min – 1.75 MU bd
Intermittent haemodialysis – 1 MU bd + 1 MU after each
episode of dialysis
Continuous renal replacement – 4.5 MU bd
Co-trimoxazole (Sulphonamide/ Trimethoprim)
Bactrim® In solution N/S IV infusion: Diluted: - MUST BE DILUTED BEFRE ADMINISTRATION
Purbac® D/W 5%* Dilute in a ration of 1:30 RT: 6 hours - Protect from light until use
80/400mg/5ml D/W 10% - 5ml (1 amps) in 150ml Do not refrigerate - Solution is colourless to light yellow
OR Ringers - 10ml (2 amps) in 300ml - High fluid intake of >1.5L recommended -reduce risk of crystalluria
480mg/5ml lactate - 15ml (3 amps) in 450ml - RENAL: GFR 10-50ml/min – 75% of dose
- 20ml (4 amps) in 600ml GFR < 10ml/min – 50% of dose
Over 60-90 minutes
Ertapenem (Carbapenems)
Invanz® IV: N/S IV infusion: Diluted: - DO NOT USE diluents containing dextrose and do not mix or infuse
1g/vial 1g + 10ml WFI Dilute in 50ml N/S over 30 minutes RT: 6 hours with other medications.
(100mg/ml) FT: 24 hours and use - IV infusion over 30 minutes, or IM, 1 g once daily for 3–14 days,
IM within 4 hours once depending on the type of infection and causative pathogens.
IM: removed from fridge - RENAL: CrCl ≤ 30ml/min/1.73m2 – 500mg od
1g + 3.2ml
lidocaine 1%
Fluconazole (Triazole derivative Antifungal)
Bio-fluconazole® In solution N/S IV infusion: Discard unused portion - RENAL: GFR < 50ml/min – 50% of dose
Etomax® (2mg/ml) Ringers Infuse at a maximum rate of
200mg/100ml 200mg/hour through an existing
line with compatible liquid.
Ganciclovir (Antiviral)
Cymevene® 500mg + 10ml WFI N/S IV infusion: Reconstituted: - DO not administer via IM, S/C or rapid IV bolus
500mg/vial (50mg/ml) D/W 5% Dilute to a max. concentration of RT: 12 hours - Stop TX if neutrophil count falls below 0.5 X 109/L
Ringers 10mg/ml DO NOT refrigerate - Phlebitis occurs frequently owing to high pH of solution
lactate : 100ml over 1 hour - RENAL: GFR > 50ml/min – 50% of dose 12-24 hrly
Diluted: GFR 10-50ml/min – 25 to 50% dose 24 hrly
After reconstitution with sterile FT: 24 hours GFR < 10ml/min – 25% of dose 3 times/week
WFI, dilute in 50-250ml of
compatible IV infusion solution.
Gentamicin (Aminoglycoside)
Aspen Gentamicin® In solution N/S IV infusion: Diluted: - Flush the line with N/S after administration1
Gentamicin- (40mg/ml) D/W 5% Dilute in 50-100ml over 30-120 RT: 24 hours - Solution is colourless to light yellow
Fresenius® minutes1,3 - Narrow TI so look at age, weight and renal function for doses.
80mg/2ml Confirm efficacy of dose by measuring peak level after 2nd dose
10ml/ml IM - Measure trough level to minimise toxicity, esp. in renally impaired
patients
- od regimen recommended – less toxicity and more effective than
multi dosing
- RENAL Failure (GFR ≤ 60ml/min) – 3-4 mg/kg loading dose;
further doses according to plasma levels
- Target plasma levels: Peak >8mg/L; trough <1mg/L
Imipenem/cilastin (Carbapenems)
Tienam® 500mg + 10ml N/S N/S IV infusion: Reconstituted: - Final concentration not to exceed 5mg/ml
500/500mg/vial from infusion bag D/W 5% Dilute in 100ml RT: 4 hours - IV infusion, 500 mg 6 hourly or 1 g 8 hourly (2–3 g/day); (500 mg
(50mg/ml). D/W 10% :500mg over 20-30 minutes FT: 24 hours doses should be infused over 20–30 minutes, 1 g over 40–60
Repeat with a 5% D/saline minutes). Higher doses recommended for P. aeruginosa infections
further 10mls to Dilute in 200ml - Maximum: 50mg/kg/day up to 4g/day
ensure complete :1g over 40-60 minutes - RENAL: GFR 10-50ml/min – 50% of dose
transfer GFR <10ml/min – 25% of dose
Kanamycin (Aminoglycoside)
Biotech In solution N/S1 IV infusion: Discard unused portion - Protect from light
Kanamycin® (333mg/ml) D/W 5%1 : 500mg in 100-200ml - Solution is colourless to light yellow
1g/3ml :1G in 200-400ml Do not refrigerate - Aminoglycosides should not be mixed with other agents in the
Over 30-60 minutes1 same syringe or infusion or given via the same IV line.
- Once-daily dosage regimens are recommended for both adult and
IM* paediatric use. These show less toxicity and slightly more efficacy
than multidose regimens.
- Max.: 1.5g/day; total max. per tx period, 15g
- Reduce dose in renal impairment

Linezolid (Other Antibacterial)

Zyvoxid® In solution N/S IV infusion: Single infusion bags – - Protect from light until use
600mg/300ml (2mg/ml) D/W 5% Infuse solution over 30-120 discard unused - Solution is colourless to light yellow
ringers minutes solution - No dosage needed when switching IV to oral because f is 100%
- Oral, 600 mg 12 hourly. IV infusion over 30–120 minutes, 600 mg
12 hourly.
- In drug-resistant tuberculosis, 600 mg daily is used (off-label)
Metronidazole (Nitroimidazole derivative)
Bio Metronidazole® In solution WFI IV infusion: Discard unused portion - Protect form light
500mg/100ml (50mg/ml) N/S Infuse solution at a rate of - Avoid alcohol during and 48 hours after tx
D/W 5% 5ml/minute Do not refrigerate - Dose reductions (of at least 50%) are necessary in patients with
Ringers :500mg/100ml over 20 minutes significant liver disease.
 lactate
Meropenem (Carbapenems)
Mercide® 500mg + 10ml WFI N/S IV infusion: Reconstituted: - Solution is colourless to light yellow
Meroject® (50mg/ml) D/W 5% Dilute to conc. of 1-2mg/ml RT: 7 hours - IV, 0.5–1 g 8hrly, injected over 5min or infused over 15–30 min
500mg/vial 5% D/saline :500mg-1g in 100ml over 15-30 FT: 48 hours - Meningitis and P. aeruginosa infections: 2 g 8 hourly. Consider
1g/vial 1g + 20ml WFI minutes D/W 5%
loading doses and prolonged infusion in critically ill patients.
(50mg/ml) :2g in 200ml over 60 minutes2 Diluted: RT: 3 hours - RENAL: GFR 26-50ml/min – usual dose bd
N/S FT: 13 hours GFR 10-25ml/min – 50% bd
IV Bolus: RT: 8 hours GFR < 10ml/min – 50% od
Slowly over 3-5 minutes FT: 48 hours

Moxifloxacin (Fluoroquinolone)
Avelon® In solution N/S IV infusion: Diluted: - Protect from light
400mg/250ml D/W 5% Infuse solution over 60 minutes RT: 24 hours - Stop at first sign of tendonitis (painful sweeling, inflammation)
D/W 10% No further dilution is necessary Do not refrigerate – - Maintain adequate fluid intake, avoid alkalinity of urine
Ringers causes precipitation
lactate
Piperacillin/Tazobactam (Β-lactamase sensitive penicillin with extended spectrum)
Tazobax® 4.5g + 20ml WFI or N/S IV infusion: Reconstituted: - Penicillin’s and aminoglycoside must not be mixed in same syringe
Curitaz® N/S D/W 5% Dilute in 50-100ml over 30 minutes RT: 24 hours or infusion, or given simultaneously via same IV line
4g/0.5g/vial Ringers (slow IV infusion) FT: 48 hours - Immunocompromised or neutropenic patients: 4g/0.5g qid
lactate - RENAL: CrCl 20-40 ml/min – 2g/0.25g qid
Diluted: CrCl < 20 ml/min – 2g/0.25g tds
RT: 24 hours
FT: 48 hours
Tigecycline (Glycylcyclines)
Tygacil® 50mg + 5.3ml N/S N/S IV infusion: Reconstituted: - Solution is yellow-orange in colour
50mg/vial (10mg/ml) D/W 5% Dilute in 100ml over 30-60 minutes RT: 24 hours (up to 6 - IV loading dose, 100 mg followed by 50 mg 12 hourly for 5–14
(powder for Ringers hours in vial and days.
infusion) lactate remaining time in IV - A 200 mg loading dose and 100 mg maintenance dose may be
bag) considered in severe multidrug-resistant Gram-negative bacterial
infections.
Diluted: - Severe hepatic impairment: Initially 100mg followed by 25mg bd
FT: 48 hours (if
immediately
transferred to IV bag)
Tobramycin (Aminoglycoside)
Tobramycin- In solution N/S IV infusion: - Do not use larger than 21G needle to prevent fragmentation of
Fresenius ® (40mg/ml) D/W 5% Dilute in 50-100 ml over 20-60 rubber stopper.
80mg/2ml minutes - Long term management of chronic pulmonary colonisation by P.
aeruginosa in cystic fibrosis: Inhalation over 15 minutes, 300 mg
IM twice daily for 28 days. Maintenance cycle, 28 days therapy and 28
days rest
Vancomycin (Glycopeptide Antibacterial)
Gulf Vancomycin® 500mg + 10ml WFI N/S IV infusion: Reconstituted: - Infusion rate: No more than 500mg per 30 minutes to prevent
0.5g 1g + 20ml WFI D/W 5% Maximum infusion rate of 500mg RT: 8 hours red-man syndrome
1g (50mg/ml) per 30 minutes FT: 24 hours - Protect from light
:500mg in 100ml over 30 minutes - IV, 15–20 mg/kg 12 hourly. For seriously ill patients, a loading
:1g in 200ml over 60 minutes dose of 25–30 mg/kg is recommended.
- C. difficile colitis: Oral, 125–500 mg 6 hourly for 10–14 days
PO: (diluted in 30 mL of water if the solution for injection is used).
Add required dose to 30ml water - RENAL: GFR > 40-79 ml/min – dose od
GFR 25-40 ml/min – dose 48 hourly
GFR < 25 ml/min, haemodialysis or peritoneal
dialysis – give when trough < 15µg/ml
Voriconazole (Triazole derivative Antifungal)
Vfend® 200mg + 19ml WFI N/S IV infusion: Reconstituted: - Monitor patients with abnormal LFTs, on initiation or during
200mg/vial (10mg/ml) D/W 5% Dilute to a final concentration of FT: 24 hours therapy, for the development of more sever hepatic injury
D/saline 0.5-5mg/ml and run over 1-2 hours - Avoid sunlight during tx or use sunblock
(max. rate 3mg/kg per hour) - RENAL: GFR < 50 ml/min – IV not recommended
- Hepatic impairment (cirrhosis) – 50% of maintenance dose

KEY: RT: room temperature; FT: fridge temperature; D/W 5%: dextrose in water 5%; N/S: normal saline (0.9% sodium chloride); D/saline: dextrose 5%/sodium chloride 0.9%; CMS: colistimethate
sodium (prodrug)
*=Preferred vehicle/route of administration
REFERNCES: 1Medscape; 2Current practice; 3Handbook on Injectable Drugs 18th ed.; 4globalrph.com; 5Labuschagne, Q. et al.; 2016. COLISTIN: adult and paediatric guideline for South Africa, 2016.
South African Journal of Infectious Diseases, 31(1), pp.3-7.
All unreferenced information is sourced from the package inserts.
PLEASE NOTE: The dissolutions, dilutions and infusion rates are applicable to adults ONLY.
: If stability is not stated, discard any unused portion.
: Infusion volumes and rates may differ in the ICU setting.