In the case of peritonitis patients who instill only 1L or 1.5L of dialysate, when antibiotics is prescribed as an intermittent dose 1g/IP, I am concerned about whether 1g should be mixed with 2L of dialysate or 1g should be mixed with only 1L or 1.5L of dialysate left.

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Mary Chung, Nurse from South Korea asked
In the case of peritonitis patients who instill only 1L or 1.5L of dialysate, when antibiotics is prescribed as an intermittent dose 1g/IP, I am concerned about whether 1g should be mixed with 2L of dialysate or 1g should be mixed with only 1L or 1.5L of dialysate left.

1 answer

Nurse Canada with members of the ISPD Nurse Committee December 1, 2021

We thank you for your interesting question. From an informal poll of several nurses from different countries belonging to the ISPD Nursing Committee, common practice in different countries is to use the patient’s usual fill volume when antibiotics are prescribed IP for peritonitis. For an adult patient, we would not go below a 1 L fill volume.
 
Of note though, recommendations from authors of the latest ISPD peritonitis guidelines suggest dosing certain antibiotics IP based on the weight of the individual patient (1, page 48, Table 5). The specific antibiotic is prescribed then as mg/kg rather than mg/L.
 
1.Li PK, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, Fish DN, Goffin E, Kim YL, Salzer W, Struijk DG. ISPD peritonitis recommendations: 2016 update on prevention and treatment. Peritoneal Dialysis International. 2016 Sep 1;36(5):481-508. Available at: https://journals.sagepub.com/doi/pdf/10.3747/pdi.2016.00078

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