In the 2016 ISPD Peritonitis Recommendations Update on Prevention and Treatment on page 488 it is noted that the IP route is preferred unless there is also systemic sepsis. In case where IV antimicrobial therapy may be needed, what is a reasonable dose for imipenem/cilastatin ? This antimicrobial is not included in Table 6 on page 490. Ertapenem is but does not have Pseudomonal coverage. Possibly imipenem/cilastatin 500 mg IV q 12 is reasonable since ertapenem is listed at half of the normal dosing? Thanks for your time and consideration.

Questions About PD

Andrea C, Scientist from Crouse Hospital Syracuse NY asked
In the 2016 ISPD Peritonitis Recommendations Update on Prevention and Treatment on page 488 it is noted that the IP route is preferred unless there is also systemic sepsis. In case where IV antimicrobial therapy may be needed, what is a reasonable dose for imipenem/cilastatin ? This antimicrobial is not included in Table 6 on page 490. Ertapenem is but does not have Pseudomonal coverage. Possibly imipenem/cilastatin 500 mg IV q 12 is reasonable since ertapenem is listed at half of the normal dosing? Thanks for your time and consideration.

1 answer

Johann Morelle, MD, PhD February 11, 2020

We lack robust evidence about the optimal dosage of imipenem/cilastatin in the PD population, and a careful evaluation of potential risks of neurotoxicity vs. efficacy as well as the pharmacokinetic properties of imipenem/cilastatin should be considered when prescribing the drug, as discussed by Van Gelder et al, Perit Dial Int 2017 and Szeto et al, Perit Dial Int 2017.
In my personal view, the suggested dose of 500 mg IV q12h seems reasonable as (i) it is the dose recommended for patients with stage V CKD not on dialysis and for those treated with hemodialysis, and as (ii) it also corresponds to the dose recommended by Van Gelder et al, and approved by Szeto et al.
Discussion with specialists in infectious disease at your institution may also be helpful to validate the proposed regimen based on the above-mentioned references or to consider potential alternatives – if available.

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