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Part VII: Cost and recommended dosage of commonly-used antimicrobial agents

Table 7.1 Preparation and recommended dosing regimens for antibiotics

Agents Supply source (brand/generic) Dosage form (unit cost, HK$) Usual adult regimen (daily dose, route, dosing interval)1
Amikacin (163) (Amikin) Brand 250 mg vial ($41.6) I.V. 15 mg/kg (750 mg)2
q24h or 7.5 mg/kg
q12h (max 1.5 g/day)
500 mg vial ($60.6)
Amoxicillin Generic 250 mg cap. ($0.11) P.O. 500 mg t.d.s.
125 mg/5 mL syr. ($0.18/mL)
Amoxicillin-clavulanate (Augmentin) Brand / Generic 600 mg vial ($14.5) I.V. 1.2 g q8h
1.2 g vial ($8.07)
375 mg tab. ($0.88) P.O. 375 mg t.d.s.
1 g tab. ($ 1.31) P.O. 1 g b.d.
156 mg/5 mL syr. ($0.11/mL) P.O. 312 mg (10 mL) t.d.s. (syr.)
457 mg/5 mL syr. ($0.36/mL) P.O. 914 mg (10 mL) b.d. (syr.)
Ampicillin Generic 500 mg vial ($2.22) I.V. 1 g q6h
250 mg cap. ($0.28) P.O. 250–500 mg q.i.d.
500 mg cap. ($0.48)
125 mg/5 mL syr. ($0.44/mL)
Ampicillin-sulbactam (Unasyn) Brand / Generic 750 mg vial ($8.20) I.V. 1.5–3 g q6h (max 12 g/day)
375 mg tab. ($6.92) P.O. 375–750 mg b.d.
250 mg/5 mL syr. ($1.55/mL)
Azithromycin (Zithromax) Brand / Generic 500 mg vial ($109) I.V. 500 mg q24h
250 mg tab. ($1.78) P.O. 500 mg on first day then 250 mg once daily
250 mg cap. ($13.1)
200 mg/5 mL syr. ($1.39/mL)
Cefazolin Generic 1 g vial ($2.74) I.V. 1 g q8h
Cefepime (Maxipime) Brand 1 g vial ($40.2) I.V. 1–2 g q12h (max 6 g/day)
2 g vial ($204)
Cefoperazone-sulbactam (Sulperazon) Generic 1 g vial ($5.60) I.V. 1–2 g q12h (max 8 g/day)
Ceftazidime (Fortum) Brand / Generic 500 mg vial ($10.0) I.V. 1–2 g q8h (max 6 g/day)
1 g vial ($12.1)
2 g vial ($209)
Cefotaxime (Claforan) Generic 1 g vial ($3.99) I.V. 1 g q6–8h (max 12 g/day)
Ceftaroline (Zinforo) Brand 600 mg vial ($344) I.V. 600 mg q12h
Ceftriaxone (Rocephin) Brand / Generic 250 mg vial for I.M. injection ($80.8) I.M. 250 mg once
1 g vial for I.M. or
I.V. injection ($4.85)		 I.M./I.V. 1–2 g/day
q12–24h (max 4 g/day)
Cefuroxime (Zinacef) Brand / Generic 250 mg vial ($14.0) I.V. 750 mg–1.5 g q8h (max 6 g/day)
750 mg vial ($2.94)
Cefuroxime-axetil (Zinnat) Brand / Generic 125 mg tab. ($4.01) P.O. 250–500 mg b.d.
250 mg tab. ($0.77)
125 mg/5 mL suspension ($1.24/mL)
Cephalexin Generic 250 mg cap. ($0.39) P.O. 250–500 mg q.i.d.
Ciprofloxacin (Ciproxin) Brand / Generic 200 mg vial ($60.4) I.V. 200–400 mg q12h
400 mg vial ($677)  
250 mg tab. ($0.41) P.O. 500–750 mg b.d.
Clarithromycin (Klacid) Brand / Generic 500 mg vial ($118) I.V. 500 mg q12h
250 mg tab. ($0.99) P.O. 250–500 mg b.d.
500 mg tab. ($1.81)
500 mg modified release tab. ($28.4)
125 mg/5 mL suspension ($0.52/mL)
Clindamycin (Dalacin C) Brand / Generic 300 mg vial ($9.51) I.V. 600–900 mg q8h
(max 4.8 g/day)
300 mg ampoule ($9.26)
150 mg cap. ($3.15) P.O. 150–450 mg q.i.d.
Cloxacillin Generic 500 mg vial ($4.14) I.V. 500 mg–1 g q6h
(max 8 g/day)
250 mg cap. ($0.32) P.O. 500 mg q.i.d.
500 mg cap. ($0.39)
Colistin (Colomycin) Brand 1 million unit vial ($153) I.V. 1–2 million unit q8h (max 6 million unit/day)
Daptomycin (Cubicin) Brand 500 mg vial ($1,389) I.V. 4 mg/kg (complicated skin and skin structure infections) or 6 mg/kg
(S. aureus bloodstream infection) q24h
Doxycycline (Vibramycin) Brand 100 mg tab. ($1.33) P.O. 100 mg b.d.
Ertapenem (Invanz) Brand 1 g vial ($230) I.V. 1 g q24h
Erythromycin (Erythrocin) Generic 500 mg vial ($583) I.V. 500 mg q6h (max 4 g/day)
250 mg tab. ($0.86) P.O. (tab.) 250–500 mg q.i.d.
200 mg/5 mL suspension ($0.21/mL) P.O. (suspension) 400–800 mg q.i.d
Flucloxacillin Generic 125 mg/5 mL solution ($0.14/mL) P.O. 250–500 mg q.i.d.
Fosfomycin Fosfocina3 4 g vial ($478) I.V. 8–12 g/day (100–200 mg/kg/day)
Monurol 3 g sachet (not in HA formulary) ($30.3) P.O. 3 g sachet for 1 dose for uncomplicated urinary tract infection
Gentamicin (163) Generic 80 mg ampoule ($3.72) I.V. 3.5 mg/kg (180 mg)2 q24h or 1.2 mg/kg q8h
Imipenem-cilastatin (Tienam) Brand 500 mg vial ($32.2) I.V. 500 mg q6h (max 4 g/day)
Levofloxacin (Cravit) Generic 500 mg infusion bottle ($58.4) I.V. 500 mg q24h
100 mg tab. ($0.89) P.O. 500 mg once daily
250 mg tab. ($0.66)
Linezolid (Zyvox) Brand 600 mg infusion bag ($480) I.V. 600 mg q12h
600 mg tab. ($455) P.O. 600 mg b.d.
100 mg/5 mL suspension ($15.1/mL)
Meropenem (Meronem) Generic 500 mg vial ($19.5) I.V. 1 g q8h
1g vial ($32.8)
Metronidazole (Flagyl) Generic 500 mg vial ($4.53) I.V. 500 mg q8h
200 mg tab. ($0.12) P.O. 400 mg t.d.s.
200 mg/5 mL syr. ($1.36/mL)
Minocycline Generic 100 mg vial ($86.3) I.V. 200 mg loading then 100 mg q12h
100 mg cap. ($5.21) P.O. 200 mg loading then 100 mg b.d.
50 mg cap. ($1.98)
Moxifloxacin (Avelox) Brand 400 mg infusion bottle ($312) I.V. 400 mg q24h
400 mg tab. ($34.4) P.O. 400 mg once daily
Penicillin G Generic 1 million unit vial ($6.56) I.V. 1–2 million unit q4–6h (max 24 million unit/day)
Piperacillin Generic 4 g vial ($24.7) I.V. 4 g q6–8h
Piperacillin-tazobactam (Tazocin) Generic 4.5 g vial ($18.9) I.V. 4.5 g q6–8h
Teicoplanin (Targocid) Brand 200 mg vial ($473) I.V. 6 mg/kg (400 mg) on first day, followed by 3 mg/kg (200 mg) q24h
Ticarcillin-clavulanate (Timentin) Generic 3.2 g vial ($45.7) I.V. 3.2 g q4–6h (max 19.2 g/day)
Tigecycline (Tygacil) Brand 50 mg vial ($476) I.V. 100 mg loading then 50 mg q12h
Tobramycin (163) Generic 80 mg vial ($76.7) I.V. 3.5 mg/kg (180 mg)2
q24h or 1.2 mg/kg
q8h (max 5 mg/kg/day)
Vancomycin (Vancocin) Generic 500 mg vial ($13.6) I.V. 1 g q12h or I.V. 500 mg q6h (i.e. 30 mg/kg/day)
25 mg/mL oral solution (compounding supply from pharmacy) P.O. 125 mg q.i.d. (for refractory C. difficile colitis)

 

Note: Unit cost of each preparation updated as of June 2016 in HA.

  1. 1Dosage for a 70 kg person with normal renal function. Dosage modification may be necessary for (i) the elderly; (ii) the very obese individuals (in whom the distribution volume of water-soluble drugs may be smaller than expected from body mass); (iii) those with renal failure and/or (iv) liver failure.
  2. 2Dosage for a typical 50 kg person given. Once daily administration of aminoglycoside is appropriate for most infections with the possible exceptions of neutropenic fever, infective endocarditis and in the presence of severe renal failure.
  3. 3Named patient basis only.

 

Table 7.2 Cost comparison of selected I.V. and P.O. antibiotics

Antibiotics Usual dosage Cost (HK$/day)
Aminoglycosides
I.V. gentamicin1 (3.5 mg/kg/day) 180 mg q24h 11.2
I.V. tobramycin1 (3.5 mg/kg/day) 180 mg q24h 230
I.V. amikacin1 (15 mg/kg/day) 750 mg q24h 102
Penicillins
I.V. ampicillin 500 mg –1 g q6h 9–18
I.V. cloxacillin 500 mg –1 g q6h 17–33
I.V. amoxillin-clavulanate 1.2 g q8h 24
I.V. ampicillin-sulbactam 1.5 g q6h 66
I.V. ticarcillin-clavulanate 3.2 g q6h 183
I.V. piperacillin 4 g q8h 74
I.V. piperacillin-tazobactam 4.5 g q8h
(4.5 g q6h)		 57
(76)
Cephalosporins
I.V. cefuroxime 750 mg q8h 9
I.V. cefazolin 1 g q8h 8
I.V. ceftriaxone 1 g q12h 10
I.V. cefotaxime 1 g q8h 12
I.V. cefoperazone-sulbactam (Sulperazon) 1 g q12h 11
I.V. cefepime 1 g q12h 80
I.V. ceftazidime 1 g q8h 36
I.V. ceftaroline 600 mg q12h 688
Carbapenems
I.V. meropenem 500 mg q8h
(1 g q8h)		 59
(98)
I.V. imipenem-cilastatin 500 mg q6h 129
I.V. ertapenem 1 g q24h 230
Fluoroquinolones
I.V. moxifloxacin 400 mg q24h 312
P.O. moxifloxacin 400 mg once daily 34
I.V. levofloxacin 500 mg q24h 58
P.O. levofloxacin 500 mg once daily 1
I.V. ciprofloxacin 400 mg q12h 1,354
P.O. ciprofloxacin 500 mg b.d. 2
Macrolides
I.V. clarithromycin 500 mg q12h 236
I.V. azithromycin 500 mg q24h 109
I.V. erythromycin 500 mg q6h 2,332
Others
I.V. metronidazole 500 mg q8h 14
I.V. vancomycin 1 g q12h 54
I.V. linezolid (P.O. linezolid) 600 mg q12h
(600 mg b.d.)		 960
(910)

 

Note: Approximate cost updated as of June 2016 in HA.

  1. 1Dosage for a typical 50 kg person.

 

Table 7.3 Cost comparison of systemic antifungal agents

Antifungal agent Usual dosage Cost (HK$/day)
P.O. itraconazole (capsule) 200 mg b.d. 9
P.O. itraconazole (solution) 200 mg b.d. 285
I.V. itraconazole 200 mg q12h 1,473
P.O. fluconazole (capsule) 100–400 mg once daily 3–13
P.O. fluconazole (suspension) 100–400 mg once daily 81–323
I.V. fluconazole 200–400 mg q24h 82–165
P.O. posaconazole (suspension) Prophylaxis: 200 mg t.d.s. 564
P.O. voriconazole 200 mg b.d. 889
I.V. voriconazole1 Loading 6 mg/kg (300 mg) q12h (Day 1) 1,822–3,644
Maintenance 4 mg/kg (200 mg) q12h
I.V. anidulafungin Candidaemia:
Loading 200 mg (Day 1)
Maintenance 100 mg q24h		 768–1,535
Oesophageal candidiasis:
Loading 100 mg (Day 1)
Maintenance 50 mg q24h		 768
I.V. micafungin Prophylaxis in haematopoietic stem cell transplantation (HSCT):
50 mg q24h		 321
Candidaemia, acute disseminated candidiasis, Candida peritonitis and abscesses:
100 mg q24h		 642
Oesophageal candidiasis:
150 mg q24h		 964
I.V. caspofungin Invasive aspergillosis:
Loading 70 mg (Day 1)
Maintenance 50 mg q24h		 2,000 (70 mg)
2,975 (50 mg)
I.V. amphotericin B
(1 mg/kg/day)1
 50 mg q24h 197
I.V. liposomal amphotericin B
(3 mg/kg/day)1		 150 mg q24h 5,045

 

Note: Approximate cost updated as of June 2016 in HA.

  1. 1Dosage for a typical 50 kg person.

 

Table 7.4 Dosage of antimicrobial agents for central nervous system infections

Antibiotics1 Recommended doses Cost (HK$/day)
I.V. cefotaxime 2 g q4h 48
I.V. ceftriaxone 2 g q12h 19
I.V. cefepime 2 g q8h 612
I.V. meropenem 2 g q8h 197
I.V. ampicillin 2g q4h 53
I.V. penicillin G 3–4 million unit q4h 118–157
I.V. metronidazole 500 mg q6h 18
I.V. vancomycin 1 g q12h 54
P.O. rifampicin2 600 mg once daily 1

 

Note:

  1. 1Dosage for a typical body weight ≥70 kg and normal renal function.
  2. 2Rifampicin should only be used in combination with another antibiotic for meningitis by certain bacteria (e.g. multi-resistant Streptococcus pneumoniae or MRSA) with documented sensitivity in susceptibility testing.

 

Table 7.5 Intra-peritoneal antibiotic dosing recommendations for patients with continuous ambulatory peritoneal dialysis peritonitis

Antibiotics Intermittent dosing (once daily)1
(Add drug into 1 bag/day unless otherwise specified) (511)
Aminoglycosides
Amikacin 2 mg/kg
Gentamicin 0.6 mg/kg
Tobramycin 0.6 mg/kg
Cephalosporins
Cefazolin 15 mg/kg
Cefepime 1 g
Ceftazidime 1–1.5 g
Others
Ampicillin-sulbactam 2 g q12h
Imipenem-cilastatin 1 g q12h

 

Note:

  1. 1In patients with residual renal function, the drug dose should be empirically increased by 25%.