Beta-Lactam Antibiotic Dosing for Peritonitis in Peritoneal Dialysis Patients
For peritoneal dialysis patients with peritonitis in the outpatient setting, cefepime should be administered at a dose of 2g intraperitoneally every 48 hours. 1
Antibiotic Selection and Administration
- Empiric therapy for peritoneal dialysis-associated peritonitis should include coverage for both Gram-positive and Gram-negative organisms 2
- Intraperitoneal (IP) administration of antibiotics is superior to intravenous (IV) dosing for treating peritoneal dialysis peritonitis, with lower treatment failure rates 3
- Beta-lactams, particularly cefepime, are effective as monotherapy for peritoneal dialysis-related peritonitis when administered intraperitoneally 2
Dosing Recommendations for Beta-Lactams in PD Patients
- For patients receiving continuous ambulatory peritoneal dialysis (CAPD), cefepime should be administered at 2g intraperitoneally every 48 hours 1
- Cephalosporins can be administered intermittently or continuously with similar efficacy rates for treating peritonitis 3
- Antibiotic measurements should be performed when the patient is clinically stable and at least 1 month after resolution of a previous peritonitis episode 4
Special Considerations
- All measurements of peritoneal solute clearance should be obtained when the patient is clinically stable and at least 1 month after resolution of an episode of peritonitis 4
- Peritonitis may transiently change the patient to a high transporter status and decrease ultrafiltration per dextrose concentration used 4
- Intraperitoneal specimens for microbiological evaluation from the site of infection are always recommended for patients with healthcare-associated intra-abdominal infections or those at risk for resistant pathogens 4
Monitoring and Follow-up
- More frequent measurements of peritoneal urea clearance or residual kidney function should be obtained when clinically indicated, especially in patients with failure to thrive with no alternative explanation 4
- Peritonitis remains a major complication in patients undergoing peritoneal dialysis and requires prompt, appropriate antibiotic therapy 2
- Each dialysis center should monitor its own microbiology patterns as some centers have reported significant changes in organism distribution over time, including increases in extended spectrum beta-lactamase (ESBL) producing organisms 2
Dosing Adjustments
- For patients with minimal residual kidney function, a continuous (rather than intermittent) 24-hour peritoneal dialysis dwell prescription should be used to maximize middle-molecule clearance 4
- In patients with peritonitis who are not responding to initial therapy, consider increasing the dialysis dose 4
- Regardless of delivered dose, if a patient is not thriving and has no other identifiable cause other than possible kidney failure, consideration should be given to increasing the dialysis dose 4