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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
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Initial empiric antibiotic selection for peritonitis in patients on peritoneal dialysis

Initial empiric antibiotic selection for peritonitis in patients on peritoneal dialysis
Initiate combination therapy to cover gram-positive and gram-negative organisms*
  • Intraperitoneal vancomycin (preferred) or intraperitoneal cefazolin (alternative) for gram-positive coverage
  • plus
  • Gram-negative coverage with 1 of the following:
    • Intraperitoneal ceftazidime (preferred)
    • Intraperitoneal cefepime
    • Intraperitoneal ceftriaxone
    • Intraperitoneal carbapenem (eg, meropenem)
    • Intraperitoneal aztreonam
    • Oral or intraperitoneal fluoroquinolone (eg, ciprofloxacin)
    • Intraperitoneal aminoglycoside (eg, gentamicin)Δ
This table addresses patients who are not septic or bacteremic. Patients with sepsis or bacteremia should receive initial empiric antibiotics via the intravenous rather than the intraperitoneal route. Selection of empiric regimens should be based on patients' prior culture results and local resistance rates. Once an organism is identified by culture, antibiotic coverage should be narrowed to target the pathogen. For dosing, refer to UpToDate content.

* We administer antifungal prophylaxis to patients on peritoneal dialysis who are treated with antibiotics for longer than 3 days; other experts do so for any antibiotic course longer than 1 day. For details, refer to UpToDate content on fungal peritonitis in peritoneal dialysis.

¶ We use vancomycin for empiric gram-positive coverage because the majority of coagulase-negative staphylococci are resistant to beta-lactams, as are many Staphylococcus aureus isolates. In centers where methicillin-resistant S. aureus (MRSA) rates are low, some experts use intraperitoneal cefazolin because many coagulase-negative staphylococci reported as resistant to beta-lactams are susceptible at the high cefazolin concentrations achieved in peritoneal fluid.

Δ Once susceptibility results are available, we switch to a non-aminoglycoside class of antibiotics, if possible, to prevent ototoxicity.
Graphic 143362 Version 1.0

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