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Notice that the if statement blocks shown in Example 5-2 each contain only a single statement, one call to WriteLine( ). In such cases, you can leave out the braces enclosing the if block. Thus, you might rewrite Example 5-2 as shown in Example 5-3.

Table 30 11 Use of antimicrobials in patients with renal failure1 and hepatic failure (continued)

Proposed Dosage Regimen in End-Stage Renal Failure (all doses IV unless stated otherwise) Initial Dose3 200 mg PO 1g 05 g IV 150 mg 15 g 1 2 million units 4 mg/kg 3g 200 400 mg 600 mg PO 800 mg PO 3g 100 mg 320 mg TMP + 1600 mg SMZ 45 mg/m2 1g 200 mg orally; avoid IV in renal failure Maintenance Dose 200 400 mg q24h PO 05 1 g q24h 05 g q8h 150 mg q24h 15 g q4h 1 million units q8h 4 mg/kg q24h 2 g q6 8h 200 mg q6 8h PO 400 mg q12h PO 600 mg q24h PO 800 mg q24h PO 2 g q6 8h 50 mg q12h 80 mg TMP + 400 mg SMZ q12h 40 mg/m2 q24h 1 g q6 10d based on serum levels8 200 mg orally twice daily; avoid IV in renal failure

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Drug Ketoconazole Meropenem Metronidazole Micafungin Nafcillin Penicillin G Pentamidine Piperacillin and piperacillin + tazobactam Posaconazole Rifampin Telithromycin Ticarcillin Tigecycline Trimethoprim-sulfamethoxazole Trimetrexate Vancomycin Voriconazole

Principal Mode of Excretion or Detoxification Hepatic Renal Liver Bilary/hepatic Liver 80%; kidney 20% Tubular secretion Not known Renal 50 70%; biliary 20 30% Hepatic Hepatic Hepatic Tubular secretion Hepatic Some liver

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Approximate Half-Life in Serum Normal 8 hours 1 hour 6 10 hours 15 hours 075 hour 05 hour 6 9 hours 1 hour 20 66 hours 2 3 hours 7 10 hours 11 hours 25 40 hours TMP 10 12 hours; SMZ 8 10 hours 15 hours 6 hours 6 24 hours; dosedependent Renal Failure2 8 hours 5 10 hours 6 10 hours 15 hours 15 hours 7 10 hours 6 9 hours 3 6 hours 20 66 hours 3 5 hours 7 10 hours 15 20 hours 25 40 hours TMP 24 48 hours; SMZ 18 24 hours Not known 6 10 days 6 24 hours

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For cephalosporins, see text and Tables 30 5 and 30 6; for aminoglycosides, see Table 30 7 Considered here to be marked by creatinine clearance of 10 mL/min or less 3 For a 70-kg adult with a serious systemic infection 4 Dose adjustment in hepatic failure has not been studied, but because clearance of the drug is principally hepatic, dose reduction may be required 5 Pharmacokinetics and dosing are in reference to the active agent, penciclovir 6 When creatinine clearance is 30 mL/min, a dose of 60 mg/kg is given once daily For clearances less than 30 mL/min, the dose has not been established 7 Oral valganciclovir is same as IV ganciclovir except that the initial dose is 900 mg, maintenance dose is 450 mg twice weekly in patients with creatinine clearance 10 40 mL/min Post doses not known 8 When serum levels reach 10 15 mcg/mL, another dose should be given

nephritis with primary tubular lesions associated with antibasement membrane antibodies If the intradermal test described below is negative, desensitization is not necessary, and a full dose of the material may be given If the test is positive, alternative drugs should be strongly considered If that is not feasible, desensitization is necessary Patients with a history of allergy to penicillin are also at an increased risk for having a reaction to cephalosporins Since the specific immunogens responsible for anaphylaxis are not known for drugs other than penicillin, skin testing with cephalosporins is not recommended A common approach to these patients is to assess the severity of the reaction If an IgE-mediated reaction to penicillin can be excluded by history, a cephalosporin can be administered When the history justifies concern about an immediate-type reaction, penicillin skin testing should be performed If the test is negative, a cephalosporin can be given If the test is positive, there is a 5 10% chance of cross reactivity, and cephalosporin desensitization should be performed

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