Initial IP loading dose | Maintenance IP dose administered with all exchanges following a loading dose, if indicated NOTE: Intermittent regimens, which are listed in a separate table, are preferred for initial treatment in most patients with peritoneal dialysis-associated peritonitis. For additional information refer to legend below and UpToDate topic on microbiology and therapy of peritonitis in peritoneal dialysis. | |
Aminoglycosides | ||
We do not administer IP aminoglycosides continuously | ||
Carbapenem | ||
Imipenem-cilastatin* | 250 mg/L dialysate | 50 mg/L dialysate |
Meropenem | None | 125 mg/L dialysate |
Cephalosporins | ||
Cefazolin¶ | 500 mg/L dialysate | 125 mg/L dialysate |
Cefepime¶ | 500 mg/L dialysate | 125 mg/L dialysate |
CefoperazoneΔ | 500 mg/L dialysate | 62.5 to 125 mg/L dialysate |
Ceftazidime¶ | 500 mg/L dialysate | 125 mg/L dialysate |
Penicillins | ||
Amoxicillin◊ | None | 150 mg/L dialysate |
Ampicillin§ | None | 125 mg/L dialysate |
Ampicillin-sulbactam¥ | 750 to 1000 mg/L dialysate | 100 mg/L dialysate |
Penicillin G | 50,000 units/L dialysate | 25,000 units/L dialysate |
Glycopeptides | ||
TeicoplaninΔ | 400 mg in one bag | 20 mg/L dialysate |
Vancomycin | 2 grams in one bag | 25 mg/L dialysate‡ |
Others | ||
Aztreonam | 500 mg/L dialysate | 250 mg/L dialysate |
Ciprofloxacin† | None | 50 mg/L dialysate |
Clindamycin | None | 600 mg per bag |
Daptomycin | 100 mg/L dialysate | 20 mg/L dialysate |
Ofloxacinנ | 200 mg in one bag | 25 mg/L dialysate |
Polymyxin B | None | 300,000 units (30 mg) per bag |
Oral options that provide adequate levels within the peritoneum: Refer to separately available table of intermittently administered antibiotics in peritoneal dialysis-associated peritonitis. |
IP: intraperitoneal.
* 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%.
Δ Not available in the United States.
◊ Solution for injection is not available in the United States.
§ For enterococcal peritonitis, we avoid ampicillin because some in vitro data suggest that its activity against Enterococcus may be limited in peritoneal fluid.
¥ Dose is expressed as total grams of ampicillin-sulbactam. Ampicillin-sulbactam is formulated in a 2:1 ratio (eg, 3 grams of ampicillin-sulbactam contains 2 g ampicillin and 1 g sulbactam).
‡ We do not check serum vancomycin levels. If the maintenance dose is 25 mg/L, the serum vancomycin level will not exceed 25 mg/L.
† We generally avoid fluoroquinolones because they have significant adverse effects, increase the risk of Clostridioides difficile infection, and some have numerous drug interactions. Refer to UpToDate topic on microbiology and therapy of peritonitis in peritoneal dialysis.Do you want to add Medilib to your home screen?