IP dose instilled in the longest dwell of the day of at least 6 hours | |
Aminoglycosides* | |
Amikacin | 2 mg/kg in one exchange per day¶ |
Gentamicin | 0.6 mg/kg in one exchange per day¶ |
NetilmicinΔ | 0.6 mg/kg in one exchange per day¶ |
Tobramycin | 0.6 mg/kg in one exchange per day¶ |
Carbapenems | |
Imipenem-cilastatin | 500 mg in alternate exchanges◊ |
Meropenem | 1 gram in one exchange per day |
Cephalosporins¶ | |
Cefazolin§ | 15 to 20 mg/kg in one exchange per day |
Cefepime§ | 1 gram in one exchange per day |
Cefotaxime | 500 to 1000 mg in one exchange per day |
Ceftazidime§ | 1 to 1.5 grams in one exchange per day |
Ceftriaxone | 1 gram in one exchange per day |
Glycopeptides | |
Vancomycin | 25 mg/kg ideal body weight; re-dose once serum level is ≤15 mcg/mL¥ |
TeicoplaninΔ | 15 mg/kg in one exchange every 5 days |
Penicillins | |
NOTE: For dosing of most penicillins for IP administration, refer to separately available UpToDate table for continuous administration of IP antibiotics. | |
Ampicillin‡ | 4 grams in one exchange per day |
Other | |
Aztreonam | 2 grams in one exchange per day |
Ciprofloxacin† | Oral: 250 mg twice per day |
Daptomycin | 300 mg in one exchange per day |
Fosfomycin** | 4 grams in one exchange per day |
Linezolid | Oral: 600 mg twice per day |
Moxifloxacin† | Oral: 400 mg once per day |
Trimethoprim-sulfamethoxazole (co-trimoxazole) | Oral: One double-strength tablet (trimethoprim 160 mg and sulfamethoxazole 800 mg) two times per day |
Antifungal | |
Fluconazole | 200 mg in one exchange every 24 to 48 hours |
Voriconazole | 2.5 mg/kg in one exchange per day |
IP: intraperitoneal.
* To determine weight-based dose of aminoglycosides in patients who are overweight, use "ideal body weight"; if obese, use "dosing weight." A calculator for determining "ideal body weight" and "dosing weight" based on inputs of actual body weight and height is available in UpToDate.
¶ Systemic toxicity can occur with prolonged or repeated course(s) of IP-administered aminoglycosides. Once culture and sensitivity results are available, early switch to another appropriate class of antibiotic is suggested to decrease the risk of toxicity. Refer to UpToDate topics on microbiology and therapy of peritonitis in peritoneal dialysis.
Δ Not available in the United States.
◊ Dose is expressed as mg of imipenem.
§ For patients with significant residual kidney function (ie, urine output >100 mL/day), we increase the dose by 25%.
¥ Obtain daily vancomycin serum levels. Re-dose once the serum level reaches ≤15 mcg/mL, which usually occurs within 4 to 7 days following an IP-administered dose. If serum levels are available only once every 2 to 3 days, it is reasonable to re-dose once the level reaches ≤20 mcg/mL. Supplemental doses may be needed in patients receiving machine-assisted automated peritoneal dialysis.
‡ For enterococcal peritonitis, we avoid ampicillin because some in vitro data suggest that its activity against Enterococcus may be limited in peritoneal fluid.
† We generally avoid fluoroquinolones because they have significant adverse effects, increase the risk of Clostridioides difficile infection, and have numerous drug interactions (including with oral phosphate binders). Refer to UpToDate topics on microbiology and therapy of peritonitis in peritoneal dialysis.
** In the United States, fosfomycin is not available in the formulation necessary for intraperitoneal use.Do you want to add Medilib to your home screen?