1. Cefazolin in chronic hemodialysis patients: a safe, effective alternative to vancomycin.
- Author
-
Fogel MA, Nussbaum PB, Feintzeig ID, Hunt WA, Gavin JP, and Kim RC
- Subjects
- Ambulatory Care, Anti-Bacterial Agents adverse effects, Anti-Bacterial Agents pharmacokinetics, Bacteremia blood, Bacteremia drug therapy, Cefazolin adverse effects, Cefazolin pharmacokinetics, Cephalosporins adverse effects, Cephalosporins pharmacokinetics, Drug Therapy, Combination, Enterococcus drug effects, Gentamicins adverse effects, Gentamicins pharmacokinetics, Gentamicins therapeutic use, Gram-Negative Bacterial Infections blood, Gram-Positive Bacterial Infections blood, Humans, Metabolic Clearance Rate physiology, Methicillin Resistance, Microbial Sensitivity Tests, Staphylococcus drug effects, Vancomycin adverse effects, Vancomycin pharmacokinetics, Wound Infection blood, Wound Infection drug therapy, Anti-Bacterial Agents therapeutic use, Cefazolin therapeutic use, Cephalosporins therapeutic use, Gram-Negative Bacterial Infections drug therapy, Gram-Positive Bacterial Infections drug therapy, Renal Dialysis, Vancomycin therapeutic use
- Abstract
Vancomycin use is common in hemodialysis patients, due in part to the ease of dosing, but can lead to the development of resistant organisms, including vancomycin-resistant enterococcus. Alternate antibiotics may be equally effective and allow similar dosing in the chronic hemodialysis population. A retrospective review of culture results from a 217-patient, non-hospital-based outpatient hemodialysis center was performed over a 7-month period. Wound and blood culture sensitivity to cefazolin, vancomycin, cefazolin plus gentamicin, and vancomycin plus gentamicin was analyzed. Cefazolin was equivalent to vancomycin for empiric treatment of clinically significant infections in a population with a low rate of methicillin-resistant Staphylococcus aureus infection. Cefazolin plus gentamicin was superior to vancomycin alone. The vancomycin plus gentamicin combination did provide minimally broader coverage than the cefazolin plus gentamicin combination. A prospective pharmacokinetic analysis of postdialysis cefazolin dosing was performed in anuric chronic hemodialysis patients dialyzed with polysulfone dialyzers. Peak, predialysis, and postdialysis cefazolin levels were obtained. Nondialysis clearance of cefazolin was sufficiently low (k(e), 0.027; t(1/2), 26.4 hours) and dialysis clearance sufficiently high (k(e), 0.254; t(1/2), 3.19 hours) to provide for safe and effective peak and trough cefazolin levels with postdialysis dosing in anuric hemodialysis patients. In conclusion, cefazolin alone or with gentamicin in an appropriate empiric antibiotic choice in chronic hemodialysis patients dialyzed in a nonhospital setting with low methicillin-resistant S. aureus infection rates. For infections with documented sensitivity to cefazolin, a 1 g intravenous dose postdialysis (750 mg in patients weighing <50 kg) is safe and effective.
- Published
- 1998
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