Table 1.

Antibiotic Dosing in Hemodialysis Patients

Systemic Antibiotics
Antibiotic	Dosing Regimen
Vancomycin	20-mg/kg loading dose infused during the last hour of the dialysis session,  then 500 mg during the last 30 min of each subsequent dialysis session
Gentamicin (or tobramycin)	1 mg/kg, not to exceed 100 mg, after each dialysis session
Ceftazidime	1 g IV after each dialysis session
Cefazolin	20 mg/kg IV after each dialysis session
Daptomycin	6 mg/kg after each dialysis session

Antibiotic Lock
	Volume of Solution (mL)
Type of Lock Solution	Vancomycin*	Ceftazidime†	Cefazolin†	Heparin‡
Vancomycin/ceftazidime	1.0	0.5	—	0.5
Vancomycin	1.0	—	—	1.0
Ceftazidime	—	1.0	—	1.0
Cefazolin	—	—	1.0	1.0

Note: Empirical dosing, pending culture and sensitivity results, should include vancomycin with a third-generation cephalosporin or an aminoglycoside. Cefazolin may be used in place of vancomycin in units with a low prevalence of methicillin-resistant staphylococcus. Treatment duration is 3 weeks for uncomplicated bacteremia and 6 weeks for patients with metastatic infection. The antibiotic/heparin lock solution is prepared by the dialysis nurse immediately before instillation into the catheter lumen by mixing in a single syringe the appropriate solutions used for systemic administration of antibiotics, as indicated. If the volume of the catheter lumen is greater than 2 mL, the difference should be made up with an additional volume of heparin.

Abbreviation: IV, intravenously.

^*Vancomycin, 5 mg/mL (in normal saline solution).

^†Ceftazidime and cefazolin, 10 mg/mL (in normal saline solution).

^‡Heparin, 1,000 U/mL.