Second-line drugs in chronic kidney disease (CKD)
| Chronic kidney disease | |||
| Drug | GFR (ml/min) | Dose | Dialysis |
| Streptomycin* | 20–50 | 50–100% daily (7.5–15 mg/kg every 24 h) | HD as for GFR <10 ml/min CAVH as for GFR 10–20ml/min |
| 10–20 | 50–100% every 24–72 h (7.5–15 mg/kg every 24–72 h) | ||
| <10 | 50–100% every 72–96 h (7.5–15 mg/kg every 72–96 h) | ||
| PAS (manufacturer states “avoid in severe renal failure”) | >50 ml/min | 100% | HD: give after HD |
| 10–50 | 50–75%† | PD: as <10 ml/min | |
| <10 | 50%† | CAVH: as <10 ml/min | |
| Ethionamide‡ | >50 | No change | No changes in HD |
| 10–50 | No change | ||
| <10 | 50% | ||
| Capreomycin§ (adjust dose to give steady state concentrations of 10 μg/ml) | >50 | 24 h dose interval | HD: give after HD |
| 10–50 | 48 h dose interval¶ | PD: no change | |
| <10 | 48 h dose interval¶ | CAVH: dose as 10–50 ml/min | |
| Cycloserine** (blood monitoring levels <30 mg/l) | >50 | 12 h dose interval | HD: no change |
| 10–50 | 12–24 h | PD: no change | |
| <10 | 24 h | CAVH: dose as 10–50 ml/min | |
↵* Intramuscular: 15 mg/kg (max 1 g daily). Dose is reduced in <50 kg and >40 years to max 500–750 mg daily or 12–15 mg/kg 2–3 times/week. Peak plasma concentrations of streptomycin should be between 15 and 40 μg/ml and trough concentrations <3–5 μg/ml or <1 μg/ml in CKD or those >50 years.
↵† Caution when reducing dose of PAS (may become subtherapeutic). Usual adult dose 4 g three times a day. ATS recommend 4 g twice daily if creatinine clearance <30 ml/min. Granules should be administered in acidic food or drink with a pH<5 (eg, fruit juice) and should be swallowed without chewing.
↵‡ Adults 15–20 mg/kg/day in single or divided doses (usual dose 500 mg–1 g daily). ATS recommend 250–500 mg daily.
↵§ Adults 1 g intramuscular every 24 h (not to exceed 20 mg/kg/day)
↵¶ or 3 times/week. Do therapeutic drug monitoring.
↵** Usual adult dose 500 mg–1 g daily in divided doses, monitored by therapeutic drug monitoring. The initial adult dosage most frequently given is 250 mg twice daily at 12 h intervals for the first 2 weeks. In severe CKD, 500 mg 3 times/week. A daily dosage of 1 g should not be exceeded. Careful monitoring for evidence of neurotoxicity.
CAVH, continuous arteriovenous haemodialysis; GFR, glomerular filtration rate; HD, haemodialysis; PAS, para-amino salicylic acid; PD, peritoneal dialysis.