Antibiotic lock solutions for adjunctive treatment of tunneled hemodialysis catheter-related blood stream infection (CRBSI)

Volume of components (mL)^*				Final concentration
Vancomycin 5 mg/mL	Ceftazidime 10 mg/mL	Cefazolin 10 mg/mL	Heparin^¶ 1000 units/mL	Final concentration
Vancomycin-ceftazidime-heparin lock
1	0.5	0	0.5	2.5 mg/mL vancomycin 2.5 mg/mL ceftazidime 250 units/mL heparin
Vancomycin-heparin lock
1	0	0	1	2.5 mg/mL vancomycin 500 units/mL heparin
Ceftazidime-heparin lock
0	1	0	1	5 mg/mL ceftazidime 500 units/mL heparin
Cefazolin-heparin lock
0	0	1	1	5 mg/mL cefazolin 500 units/mL heparin

Antibiotic lock solution is instilled ("locked") into each catheter lumen at the end of each dialysis session instead of standard heparin lock, as an adjunct to systemic antimicrobial therapy, until the catheter is replaced. For antibiotic lock therapy indications and antibiotic component selection, refer to the UpToDate review of tunneled hemodialysis catheter-related bacteremia.

* Antibiotic solution components are prepared with normal saline diluent and mixed in a single syringe immediately before instillation using aseptic methods according to local standards. Stability data are provided separately in an UpToDate table of antibiotic lock solutions for non-hemodialysis CRBSIs.

¶ If the patient has a history of or active heparin-induced thrombocytopenia, substitute normal saline for heparin. If the volume of the catheter lumen exceeds 2 mL, the difference in volume should be made up with additional heparin or normal saline.

Adapted from: Allon M. Treatment guidelines for dialysis catheter-related bacteremia: an update. Am J Kidney Dis 2009; 54:13.

Additional data from:

UpToDate Lexidrug. More information available at https://online.lexi.com/.

Graphic 126614 Version 7.0

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Antibiotic lock solutions for adjunctive treatment of tunneled hemodialysis catheter-related blood stream infection (CRBSI)