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

Functions | Account Assignment/Costing | Revenue Account Determination | Check Master Data Relevant For Account Assignment | Materials: Account Assignment Groups As the configuration is similar between revenue account determination and reconciliation account determination, we will be focusing on revenue account determination for the purposes of this book Please note this section is highly integrated with the Finance (FI) and Cost Accounting (CO) modules In the Check Master Data Relevant for Account Assignment screen, you have the opportunity to create account assignment grouping criteria This grouping criteria allows the system an extra variable in determining the required account number You can specify, as shown in Figure 8-44, whether a material should be classified as a product, service, or equipment You may define as many account assignment groups as you require To re-create new entries, you can copy the existing standard and rename the entry using a two-character alphanumeric key with a short description After the creation of these account keys, you must ensure they are assigned to the material master record on the material sales org 2 tab, as shown in Figure 8-45

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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

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

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

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

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