Treatment | Dose and schedule for adult patients* | Administration |
Vancomycin¶ | High flux: 20 mg/kg IV loading dose, then 1 g IV in last hour of each HD session Low flux: 500 mg in last hour of each HD session |
|
Ceftazidime | 1 g IV post-HD |
|
Cefepime | 1.5 to 2 g IV post-HD |
|
Cefazolin | 2 g IV post-HD |
|
Gentamicin or tobramycin | 1 to 2 mg/kg IV in last hour of each HD session (not to exceed 100 mg per dose)Δ |
|
Daptomycin | High flux: 9 mg/kg IV in last hour of each HD session Low flux: 7 mg/kg in last hour of each HD session |
|
ABW: adjusted body weight; HD: hemodialysis; IBW: ideal body weight; IV: intravenous; MIC: minimum inhibitory concentration; MSSA: methicillin-sensitive Staphylococcus aureus.
* General recommendation on dose schedule shown. Schedule may require adjustment based upon clinical setting; ie, doses may be administered either in the last hour of dialysis session or after dialysis depending upon practical considerations.
¶ This dosing may be used when serum vancomycin concentrations are unavailable. Dose recommendations based upon serum concentration monitoring are provided in a separate UpToDate topic review and table of vancomycin parenteral dosing and monitoring.
Δ In patients who require an aminoglycoside for >48 to 72 hours, UpToDate contributors obtain predialysis serum concentrations to guide adjustment of the postdialysis dose until a stable dose regimen is established. Recommendations for dose adjustment based upon serum concentrations are provided in a separate UpToDate topic review of dosing and administration of parenteral aminoglycosides.
◊ Patients with a history of mild to moderate allergy (eg, mild rash) or intolerance to penicillins or first generation cephalosporins can usually tolerate ceftazidime. Refer to separate UpToDate topic review of cephalosporin hypersensitivity and cross-reactivity.