From the Guidelines
Antibiotics Not Removed by Dialysis
Certain antibiotics are not significantly removed by dialysis, including rifampin and isoniazid 1, as well as ethionamide and p-Aminosalicylic acid 1. Additionally, moxifloxacin is also not substantially dialyzed 1.
- The dosing of these antibiotics in patients undergoing dialysis is generally similar to that in patients with normal renal function, with typical doses ranging from 250-500 mg for certain medications, administered over varying durations depending on the specific infection being treated.
- It is essential to note that the medications should be given after hemodialysis on the day of hemodialysis, and monitoring of serum drug concentrations should be considered to ensure adequate drug absorption, without excessive accumulation, and to assist in avoiding toxicity 1.
- For patients with 30–50 mL/min creatinine clearance, standard doses are used by experts, but measurement of serum concentrations 2 and 6 hours after timed administration can be used to assist with optimizing drug dosages 1.
- In patients with renal insufficiency or end-stage renal disease (ESRD), close monitoring during tuberculosis treatment is recommended, and dose adjustment may be required 1.
- Rifampin (RIF) and Isoniazid (INH) are metabolized by the liver, and conventional dosing can be used in the setting of renal insufficiency 1.
From the FDA Drug Label
The pharmacokinetic profile of tigecycline was not significantly altered in any of the renally impaired patient groups, nor was tigecycline removed by hemodialysis.
Tigecycline is not removed by dialysis.
- Key points:
- Tigecycline's pharmacokinetic profile is not significantly altered in renally impaired patients.
- Hemodialysis does not remove tigecycline. 2
From the Research
Antibiotics Not Removed by Dialysis
- Moxifloxacin pharmacokinetics in critically ill patients with acute renal failure and undergoing extended daily dialysis were similar to those in healthy subjects without renal impairment, suggesting that moxifloxacin is not significantly removed by dialysis 3
- Delafloxacin dosage adjustments are not required for patients with severe renal dysfunction, but its use is not recommended for patients on hemodialysis or with end-stage renal disease, implying that delafloxacin may not be significantly removed by dialysis 4
Antibiotics Removed by Dialysis
- Levofloxacin is removed by extended daily dialysis, but to a lesser extent than in healthy subjects, and its dosage should be reduced according to the intensity of renal replacement therapy 3
- Cefepime, daptomycin, meropenem, piperacillin/tazobactam, and vancomycin may be removed by sustained low efficiency dialysis (SLED), with varying degrees of adequacy in terms of antibiotic dosing 5
- Doripenem, meropenem, ciprofloxacin, levofloxacin, pazufloxacin, linezolid, and tedizolid can be quantified in filtrate during continuous renal replacement therapy using a UHPLC-MS/MS method, suggesting that these antibiotics may be removed by dialysis to some extent 6