Table 1.

Studies of Antibiotic Dosage Analysis in SLED.

Study	Drug	Dose	No. of subjects	Dialysis machine	SLED characteristics	Pharmacokinetics in SLED	Recommendations
Ahern et al7	Vancomycin	Single dose 15 mg/kg IV	11	Fresenius 2008 H (Fresenius medical care)	Dialysate flow rate100 mL/min and blood flow rate 200 mL/min. Dialysis duration 24 h	Mean half-life 43.1 hr and mean clearance 24.3 mL/min. Mean volume of distribution 0.84 L/kg. Mean volume of distribution 0.84 ± 0.17 L/kg	Initial dose of 15 mg/Kg and measurement of serum drug levels at 24 h
Kielstein et al8a	Vancomycin	Single dose 1 g IV 12 h prior to dialysis	10	Batch dialysis system (GENIUS, Fresenius Medical care, Bad Homburg) with polysulfone high-flux dialyzer with surface area 1.3 m2	Both dialysate and blood flow rate 160 mL/min. Dialysis duration 480 ± 6 min	Mean half-life 11.2 h. Mean clearance 2.1 L/h and 3.8 L/h based on analysis method. Mean volume of distribution 0.57 L/kg	Initial dose of 20-25 mg/kg and monitoring of drug levels for further dosing.
Manley et al9	Gentamicin*	Single dose of 0.6 mg/kg IV post dialysis	8	Fresenius Medical care, high-flux polysulfone F50 filter with surface are 0.5 m2	Blood flow rate 200 mL/min and dialysate flow rate 300 mL/min. Duration of dialysis 480 min	Mean half-life 3.7 ± 0.8 h. Mean clearance 75.9 ± 38.4 mL/min/1.73 m2. Mean volume of distribution 0.28 L/kg	2-2.5 mg/kg after hemodialysis to maintain optimal peak and trough levels at 7.5 µg/mL and 0.8 µg/mL, respectively
Kielstein et al8a	Meropenem	Single dose 1 g IV 6 h prior to dialysis	10	Batch dialysis system (GENIUS, Fresenius Medical care, Bad Homburg) with polysulfone high-flux dialyzer with surface area 1.3 m2	Both dialysate and blood flow rate 160 mL/min. Dialysis duration 480 ± 6 min	Mean half-life 3.7 h. Mean clearances 2.3 and 5.1 L/h based on analysis method. Mean volume of distribution 0.72 L/kg	0.5-1 g every 8 h
Braune et al10	Meropenem	Varying doses of 0.5 g, 1 g and 2 g IV over 30 min every 8 h	19	GENIUS batch system (Fresenius Medical Care, Bad Homburg, Germany) with Fresenius FX 60 filter (surface area 1.4 m2)	Mean SLED duration 315 min. Mean blood/dialysate flow rate 250 mL/min and ultrafiltration rate 500 mL/h.	The PTA for 40% fT >MIC and 100% fT >MIC was >95% with a meropenem dose of 0.5 g 8 hourly for Pseudomonas aeruginosa (MIC ⩽2) in patients without residual diuresis, whereas it was >95% and 93% with a dose of 1 g 12 hourly and 2 g 8 hourly, respectively, in patients with 300 mL/d residual diuresis. In patients with residual diuresis, FTA of 97% was achieved with a dose of 2 g 8 hourly for 100% fT >MIC	Pharmacokinetic properties are significantly influenced by the degree of residual diuresis in patients undergoing SLED. Therapeutic drug monitoring may help optimize individual dosing
Burkhardt et al11	Ertapenem	Single dose of 1 g IV	6	Batch dialysis system (GENIUS, Fresenius Medical care, Bad Homburg) with polysulfone high-flux dialyzer with surface area 1.3 m2	Mean blood and dialysate flow 160 mL/min. Dialysis duration 480 min	Half-life 6.7 h. Mean clearance 49.5 ± 10.9 mL/min. Volume of distribution 15.9 ± 3.2 L	1 g/d
Fiaccadori et al12	Linezolid	Single dose of 600 mg IV before dialysis	15	Fresenius Medical Care (low-flux polysulfone filters with 1.6 m2 surface area)	Blood flow 200 mL/min and dialysate flow 100 mL/min. Dialysis duration 8-9 h	Half-life 5.88 h and clearance 33.3 mL/min. Volume of distribution 30.19 L	Drug should be administered toward the end of dialysis session
Czock et al13b	Moxifloxacin	Single dose of 400 mg IV 8 h prior to dialysis	10	GENIUS batch system (Fresenius Medical Care, Bad homburg) with polysulfone high-flux dialyzer with surface area 1.3 m2	Mean blood and dialysate flow 161 ± 4 mL/min. Dialysis duration 481 ± 9 min	Mean half-life 6 h and mean clearances 2 L/h and 3.1 L/h based on analysis method. Mean volume of distribution 3.8 L/kg	Standard 400 mg/d irrespective of liver impairment
Czock et al13b	Levofloxacin	Single dose of 250/500 mg IV 12 h prior to dialysis	5	GENIUS batch system (Fresenius Medical Care, Bad homburg) with polysulfone high-flux dialyzer with surface area 1.3 m2	Mean blood and dialysate flow 161 ± 4 mL/min. Dialysis duration 481 ± 9 min	Mean half-life 10.3 h and mean clearances 2.93 L/h and 3.12 L/h based on analysis method. Mean volume of distribution 1.71 L/kg	Dosage adjustment is necessary and drug should be given after dialysis
Lorenzen et al14	Ampicillin/sulbactam	Single dose of 2 g/1 g IV 3 h prior to dialysis
Multiple doses of 2 g/1 g twice daily for 4 days	12	GENIUS batch system (Fresenius Medical Care, Bad homburg) with polysulfone high-flux dialyzer with surface area 1.3 m2	Mean blood and dialysate flow 162 ± 6 mL/min. Dialysis duration 442 ± 77 min	Mean volume of distribution for ampicillin/sulbactam were 13.1 ± 11.1 L and 22 ± 21.8 L, respectively, mean half-life 2.8 ± 0.8 h and 3.5 ± 1.5 h, respectively, mean clearances 80.1 ± 7.7 mL/min and 83.3 ± 12.1 mL/min, respectively
No significant drug toxicity with twice daily dosing	Twice daily dosing 2 g/1 g with one dose given after dialysis
Clajus et al15	Trimethoprim/sulfamethoxazole	15 mg/kg/d and 95 mg/kg/d IV	1	GENIUS batch system (Fresenius Medical Care, Bad homburg) with polysulfone high-flux dialyzer with surface area 1.3 m2	Mean blood and dialysate flow 170 ± 41 mL/min. Dialysis duration 442 ± 101 min	Clearances 94 ± 20.2 mL/min and 51 ± 18.8 mL/min, respectively	Further studies needed to establish dosing recommendations
Strunk et al16	Colistin	6 million units loading dose and 3 million units every 8 h	1	High flux 1.3 m2 dialyzer	Mean blood and dialysate flow rate 191 mL/min and 121 mL/min, respectively. Average dialysis duration 552 min	Colistin clearance 54-71 mL/min and colistin methanesulfonate 25-62 mL/min	Recommends loading dose of 6 million units and maintenance of 3 million units every 8 h
Konig et al17	Ceftazidime	1-2 g IV over 30 min 8-12 hourly	16	Genius batch system (Fresenius Medical Care, Bad Homburg, Germany) with Fresenius FX 60 filter (surface area 1.4 m2)	Mean duration of SLED 299 min. Mean blood/dialysate flow rate 264 mL/min and mean ultrafiltration 540 mL/h	Mean clearance on SLED was 5.32 L/h versus 1.06 L/h off SLED. PTA for 50% fT >MIC was 98% at a dose of 1g IV 8 hourly.	Ceftazidime at a dose of 1g IV 8 hourly and 2g IV 12 hourly is adequate for attaining 50% fT >MIC and 100% fT>MIC, respectively, for susceptible pathogens (MIC ⩽8mg/L)

Note. SLED = sustained low-efficiency dialysis; kg = kilogram; IV = intravenous; PTA = probability of the target attainment; fT >MIC = blood levels of the given drug to be more than minimum inhibitory concentration for a specified duration of the dosing interval; FTA = fractional target attainment.

^aDenotes single study but 2 different antibiotics.

^bDenotes single study but 2 different antibiotics.

^*Slow daily home dialysis