Table A1

Second-line drugs in chronic kidney disease (CKD)

Chronic kidney disease
DrugGFR (ml/min)DoseDialysis
Streptomycin*20–5050–100% daily (7.5–15 mg/kg every 24 h)HD as for GFR <10 ml/min
CAVH as for GFR 10–20ml/min
10–2050–100% every 24–72 h (7.5–15 mg/kg every 24–72 h)
<1050–100% every 72–96 h (7.5–15 mg/kg every 72–96 h)
PAS (manufacturer states “avoid in severe renal failure”)>50 ml/min100%HD: give after HD
10–5050–75%PD: as <10 ml/min
<1050%CAVH: as <10 ml/min
Ethionamide>50No changeNo changes in HD
10–50No change
Capreomycin§ (adjust dose to give steady state concentrations of 10 μg/ml)>5024 h dose intervalHD: give after HD
10–5048 h dose intervalPD: no change
<1048 h dose intervalCAVH: dose as 10–50 ml/min
Cycloserine** (blood monitoring levels <30 mg/l)>5012 h dose intervalHD: no change
10–5012–24 hPD: no change
<1024 hCAVH: 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.