Intraperitoneal antibiotic dosing recommendations for continuous administration in adult patients on peritoneal dialysis

	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
Cefoperazone^¶	500 mg/L dialysate	62.5 to 125 mg/L dialysate
Ceftazidime	500 mg/L dialysate	125 mg/L dialysate
Penicillins
Amoxicillin^Δ	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
Teicoplanin^¶	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
Ofloxacin^Δ‡	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.

This table shows the suggested dose of antibiotics for IP administration in all exchanges of peritoneal dialysate for continuous ambulatory peritoneal dialysis-associated peritonitis, without signs of systemic infection. Intermittent IP-administered regimens are preferred over the continuous regimens shown in this table for initial therapy and should be used for the duration of treatment of 2 to 3 weeks or more in patients who are responding clinically. In patients who are not improving on intermittent therapy with agent(s) that should be effective based on microbiologic data, it is reasonable to increase frequency of intermittent dosing or switch to the continuous IP dosing regimens shown in this table. Refer to UpToDate topic on microbiology and therapy of peritonitis in peritoneal dialysis for considerations in selection of antimicrobials and dosing strategy.

IP: intraperitoneal.

* Dose is expressed as mg of imipenem.

¶ Not available in the United States.

Δ 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.

Adapted from:

Li PK, Szeto CC, Piraino B, et al. Peritoneal Dialysis-Related Infections Recommendations: 2010 Update. Perit Dial Int 2010; 30:393.
Li PK, Chow KM, Cho Y, et al. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Perit Dial Int 2022; 42:110.

Graphic 79841 Version 12.0

خرید پکیج

Intraperitoneal antibiotic dosing recommendations for continuous administration in adult patients on peritoneal dialysis