Which antimicrobials should be avoided prior to hemodialysis on scheduled dialysis days?
Many antibacterial agents are water-soluble, small molecules, and not highly protein bound; thus they are well dialyzed and will require supplementation post-dialysis.
Many of these agents are already administered in a reduced dose or frequency given the reduced kidney clearance. Beta-Lactam agents such as penicillins, cephalosporins, carbapenems, and monobactams are examples of such compounds.
Aminoglycosides also exhibit similar properties. Carbapenem and imipenem can lower the seizure threshold and should be avoided altogether in patients receiving dialysis; meropenem in a reduced dose is a therapeutic alternative.
Antifungals such as fluconazole may require supplemental dosing; however, the echinocandins (caspofungin, micafungin) and the amphotericin family do not.
Antiviral agents should receive individual consideration given their varying properties. Entecavir and telbivudine appear to be removed by hemodialysis, whereas lamivudine does not.
