CEFAZOLIN IN CHRONIC-HEMODIALYSIS PATIENTS - A SAFE, EFFECTIVE ALTERNATIVE TO VANCOMYCIN

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 m ay be equally effective and allow similar dosing in the chronic hemodi alysis population. A retrospective review of culture results from a 21 7-patient, non-hospital-based outpatient hemodialysis center was perfo rmed over a 7-month period. Wound and blood culture sensitivity to cef azolin, vancomycin, cefazolin plus gentamicin, and vancomycin plus gen tamicin was analyzed. Cefazolin was equivalent to vancomycin for empir ic 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 vancom ycin plus gentamicin combination did provide minimally broader coverag e than the cefazolin plus gentamicin combination. A prospective pharma cokinetic analysis of postdialysis cefazolin dosing was performed in a nuric chronic hemodialysis patients dialyzed with polysulfone dialyzer s. Peak, predialysis, and postdialysis cefazolin levels were obtained. Nondialysis clearance of cefazolin was sufficiently low (k(e), 0.027; t1/2, 26.4 hours) and dialysis clearance sufficiently high (k(e), 0.2 54; t1/2, 3.19 hours) to provide for safe and effective peak and troug h cefazolin levels with postdialysis dosing in anuric hemodialysis pat ients. In conclusion, cefazolin alone or with gentamicin in an appropr iate empiric antibiotic choice in chronic hemodialysis patients dialyz ed in a nonhospital setting with low methicillin-resistant S aureus in fection 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. (C) 1998 by the National Kidney Foundation , Inc.