Comprehensive dosing guidelines, monitoring protocols, and clinical decision-making tools for antibiotic therapy in end-stage renal disease patients.
Most antibiotics are renally cleared. ESRD patients have reduced clearance, requiring dose adjustment or interval extension.
Administer antibiotics after dialysis for hemodialysis patients. Consider dialysis clearance for each drug.
Monitor drug levels for aminoglycosides, vancomycin, and other narrow therapeutic index drugs.
⚠️ Clinical Pearl: Vancomycin clearance correlates with CrCl. Consider higher doses for severe infections.
🚨 Critical: Monitor levels closely. Nephrotoxicity and ototoxicity are dose-limiting.
💡 Note: Ceftriaxone is the safest cephalosporin in ESRD due to dual elimination.
✅ Safe: Generally well-tolerated in ESRD with appropriate dose adjustment.
⚠️ Warning: Avoid in patients with QTc prolongation. Monitor for CNS effects.
| Drug | Target Level | Timing | Frequency | Special Considerations |
|---|---|---|---|---|
| Vancomycin | Trough: 10-20 mg/L | 30 min before dose | Before 3rd dose, then weekly | Higher targets (15-20) for severe infections |
| Gentamicin | Peak: 5-10 mg/L Trough: < 2 mg/L |
Peak: 30 min post-dose Trough: pre-dose |
Before 3rd dose, then every 3-5 days | Monitor for nephrotoxicity and ototoxicity |
| Amikacin | Peak: 15-25 mg/L Trough: < 5 mg/L |
Peak: 30 min post-dose Trough: pre-dose |
Before 3rd dose, then every 3-5 days | Higher targets for serious infections |
| Daptomycin | Trough: 5-10 mg/L | Pre-dose | Weekly | Monitor CPK weekly, discontinue if > 1000 |