Dosing Recommendations for IV Cefazolin and Azithromycin in ESRD on Hemodialysis

Cefazolin Dosing in ESRD

The Infectious Diseases Society of America recommends administering cefazolin 2 grams IV after each dialysis session, three times weekly, to maintain therapeutic levels between sessions 1
Post-dialysis administration of cefazolin prevents premature drug removal and facilitates directly observed therapy, as recommended by the Clinical Infectious Diseases guidelines 1

The Infectious Diseases Society of America notes that azithromycin requires no dose adjustment in ESRD, including patients on hemodialysis or peritoneal dialysis, and recommends a standard dose of 500 mg IV daily 1
Azithromycin undergoes primarily hepatobiliary elimination rather than renal excretion, and the standard dosing regimen of 500 mg IV daily is recommended for patients with ESRD, as stated in the Clinical Infectious Diseases guidelines 2

The Clinical Infectious Diseases guidelines recommend administering azithromycin 500 mg IV at standard time, which can be given with or separate from cefazolin, on dialysis days 2
The guidelines also recommend administering cefazolin 2 grams IV immediately after dialysis session, and azithromycin 500 mg IV daily on non-dialysis days, as part of the standard treatment regimen for patients with ESRD on hemodialysis 1, 2

The American College of Physicians and Infectious Diseases Society of America recommend that unlike clarithromycin, which requires a 50% dose reduction when creatinine clearance is less than 30 mL/min, azithromycin maintains standard dosing in patients with end-stage renal disease, including those on hemodialysis or peritoneal dialysis 3, 4
The Infectious Diseases Society of America notes that clarithromycin dosing adjustments should not be extrapolated to azithromycin, highlighting the importance of distinguishing between macrolide antibiotics in renal impairment 3, 4