However, given that biliary elimination accounts for an appreciable amount f the total clearance of ceftriaxone, slight dosage reduction may be warranted with severe hepatic dysfunction. The use of 12h dosage intervals is recommended in ESRD due to the variability in half-life data observed in anephric patients. 150 mg once Steady-state serum flucytosine level measurements are difficult to obtain. However, they may be useful in guiding dosage of flucytosine in anuria. Dosages must be adjusted based on renal function as listed below.
Limited data are available for patients receiving ketoconazole with hepatic dysfunction.
Due to the hepatotoxic potential of this agent, it is not recommended in patients with severe hepatic disease. Metronidazole metabolites accumulate in renal failure. To minimize the potential for toxicity the drug should be dosed q12h in anuria. Dosage reduction of piperacillin in hepatic disease is not necessary based on limited data. Vancomycin dosing in renal impairment should be guided by serum level measurements.