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

	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
Continuous IP administration of aminoglycosides may be used in some circumstances, such as recurrence of peritonitis with the same organism despite appropriate therapy of the initial episode with aminoglycosides using intermittent dosing. Refer to UpToDate topic on microbiology and therapy of peritonitis in peritoneal dialysis and accompanying table on intermittent IP antibiotic administration and dosing of aminoglycosides.
Carbapenem
Imipenem-cilastatin	250 mg/L dialysate	50 mg/L dialysate
Cephalosporins
Cefazolin	500 mg/L dialysate	125 mg/L dialysate
Cefepime	250 to 500 mg/L dialysate	100 to 125 mg/L dialysate
Ceftazidime	500 mg/L dialysate	125 mg/L dialysate
Penicillins
Amoxicillin*	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
Piperacillin-tazobactam	4.5 grams in one bag	1.125 grams per bag
Glycopeptides
Teicoplanin^¶	400 mg in one bag	20 mg per bag
Vancomycin	2 grams in one bag	25 mg/L dialysate^Δ
Others
Aztreonam	1 gram/L dialysate in one bag	250 mg/L dialysate
Ciprofloxacin^◊	None	50 mg/L dialysate
Clindamycin	None	600 mg per bag
Daptomycin	100 mg/L dialysate in one bag	20 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 two to three 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.
* Intravenous preparation is not available in United States.
¶ Not available in United States.
Δ 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 do not use IP-administered fluoroquinolones, even if culture results suggest that the organism may be sensitive as in vivo results can differ due to biofilm formation. 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, Szeto CC, Piraino B, et al. ISPD peritonitis recommendations: 2016 update on prevention and treatment. Perit Dial Int 2016; 36:481.

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