Intermittent administration of betalactam-antibiotics for treatment of severe infection in hemodialysis patients.

Infections are a leading cause of morbidity and mortality in hemodialysis patients. Still, due to altered pharmacokinetics and potential toxic sideeffects, safe and efficient antibiotic therapy in dialysis patients remains a major challenge. We reviewed our experience with intermittent administration of betalactam antibiotics for treatment of severe infections in hemodialysis patients. A total of 81 episodes of infection in 45 patients was assessed. All patients were treated with betalactam antibiotics (cefepime in 11 episodes, cefpirom in 33 episodes, piperacillin in 9 episodes, amoxicillin in 18 episodes, ceftazidime in 10 episodes, respectively). All antibiotics were given post hemodialysis 3x per week. Treatment was considered efficient in case of a significant decrease in CRP in addition to clinical response. Overall treatment success rate was 85% (69 episodes of infection). The decrease of CRP was 52% (6.9 +/- 5.8 to 3.3 +/- 4.9 mg/dl; p = 0.00003). The mean duration of treatment was 19 +/- 13 days. Treatment was generally well tolerated. We conclude, that severe infections in hemodialysis patients can be treated safely and efficiently with an empiric therapy with betalactam antibiotics. Intermittent administration, potentially allowing ambulatory treatment, is possible.