Compatibility of Meropenem with Different Commercial Peritoneal Dialysis Solutions

Wiesholzer, Martin; Winter, A.; Kussmann, Manuel; Zeitlinger, Markus; Pichler, Petra; Burgmann, Heinz; Reznicek, Gottfried; Poeppl, Wolfgang

doi:10.3747/pdi.2016.00018

Cited by 6 publications

(13 citation statements)

References 14 publications

(16 reference statements)

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“…This is important information for clinical use, as previous studies have shown considerable degradation of antimicrobial drugs. For example, previous studies showed that a degradation rate of antibiotic > 10% occurred with meropenem after 14 days in Extraneal und Physioneal at 6 °C, and in all tested PDFs at 25 °C, with ciprofloxacin after 4 hours in Physioneal at 25 °C, whereas no degradation of fosfomycin could be observed over the tested time in all PDFs 12,13,22 .…”

Section: Discussionmentioning

confidence: 78%

Compatibility of aztreonam in four commercial peritoneal dialysis fluids

Tobudic

Prager

Kussmann

et al. 2020

Sci Rep

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the preferable route for treatment of peritoneal dialysis related peritonitis remains the intraperitoneal administration of antibiotics admixed to peritoneal dialysis fluids. It is important to know whether the administered drug is compatible with the PD fluids and its container. In the present study the compatibility of aztreonam with four commercial PDFs at storing temperatures and duration representative for storing conditions in the clinical settings was investigated. Aztreonam concentrations were determined using high-performance liquid chromatography. The antimicrobial activity of aztreonam was evaluated using an E. coli diffusion disk inhibition assay and P. aeruginosa time-kill curves. In Extraneal evaluated at 6 °C, 25 °C and 37 °C aztreonam was stable over the whole study period of 14 days and 24 hours, respectively. In Physioneal and Nutrineal aztreonam was stable at 6 °C for up to 14 days. Antimicrobial activity was retained in all PD fluids over the whole study period. Aztreonam remained stable and was compatible with the PD fluids, particularly with Extraneal or Nutrineal, and no compensatory dose adjustment is needed when stored for up to 14 days at refrigeration temperature before use. Bacterial peritonitis is a serious complication of peritoneal dialysis (PD) which often leads to membrane failure and patients discontinuing from peritoneal dialysis and switching to hemodialysis 1. The most common bacteria isolated from patients with PD associated peritonitis (PDAP) are primarily Gram-positive cocci like Staphylococci or Streptococci, but also Gram-negative bacteria like Escherichia coli or Pseudomonas aeruginosa are frequently detected 2. Particularly P. aeruginosa peritonitis is generally severe and associated with higher frequencies of hospitalization, catheter removal and transfer from PD to hemodialysis (HD) 3-5. Thus, empiric antimicrobial therapy should cover both, the most likely Gram-positive and Gram-negative bacteria. Aztreonam is the only clinically available monobactam with its antibacterial spectrum limited to Gram-negative aerobic bacteria and could be of strong use for the treatment of Gram-negative PDAP. In case of a P. aeruginosa peritonitis the current International Society for Peritoneal Dialysis (ISPD) guidelines suggest treating with two antibiotic agents with different mechanisms of action for three weeks 1. Therefore, aztreonam might be a feasible alternative to cephalosporins or fluoroquinolones, especially due increasing rate of multidrug-resistant Gram-negative bacteria 6. Intraperitoneal (i.p.) administration of drugs is preferable to intravenous or oral routes in PDAP due to the markedly higher concentrations achieved at the target site 1. In the past, aztreonam was assumed to be more cost intensive and more difficult to handle in continuous ambulatory peritoneal dialysis (CAPD), especially compared to fluroquinolones, since it must be administered four times daily 7,8. However, more recent studies have shown that once a day i.p. administration provides sufficient serum...

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Section: Discussionmentioning

confidence: 78%

Compatibility of aztreonam in four commercial peritoneal dialysis fluids

Tobudic

Prager

Kussmann

et al. 2020

Sci Rep

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“…A stability-indicating assay was utilised in 33% of the studies ( n = 7), 12,13,19,23,28,29,31 and an antimicrobial activity assay was reported in 24% of the studies ( n = 5). 15,20,22,26,27…”

Section: Resultsmentioning

confidence: 99%

“…20 Several common β-lactam agents including amoxicillin, aztreonam, cefepime, ceftazidime, imipenem and meropenem yielded less than 6 h of stability in mixed Physioneal solution at body temperature. 11,15,20 In addition, meropenem exhibited short stability (less than 1 h) in Extraneal at body temperature. 20 Conversely, these agents were stable for at least 6 h in other studied PD solutions.…”

Section: Resultsmentioning

confidence: 99%

“…A stabilityindicating assay was utilised in 33% of the studies (n = 7), 12,13,19,23,28,29,31 and an antimicrobial activity assay was reported in 24% of the studies (n = 5). 15,20,22,26,27 Table 1 lists the stability data of b-lactam antimicrobial agents assessed as a single additive to various PD solutions. [11][12][13][14][15][16][17][18]20 Many studied b-lactam agents were stable for 7-21 days in a refrigerator and 6 h to 14 days at room temperature.…”

Section: Resultsmentioning

confidence: 99%

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Stability and compatibility of intraperitoneal antimicrobials in peritoneal dialysate solutions

Lewis,

Alves,

Ratnam

et al. 2023

Perit Dial Int

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To optimise antimicrobial administration in patients with peritoneal dialysis (PD)-related peritonitis, healthcare providers need literature-based information to develop patient-centred pharmacotherapeutic plans. Traditional PD solutions promote osmosis using dextrose or icodextrin with a lactate buffer. Newer PD solutions have modified the osmotic vehicle and buffer. Knowledge of antimicrobial compatibility and stability with newer PD solutions will assist with determining the route of antimicrobial administration as compatible and stable solutions could be delivered directly to the peritoneum using intraperitoneal administration. This review updates the compatibility and stability of antimicrobial additives in newer PD solutions for PD-related peritonitis.

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“…For an antibiotic to be administered intraperitoneally, it needs to be stable in PD solutions, which vary widely in their composition and packaging material. The stability of meropenem in 4 types of PD solution (Dianeal 2.5%, i Extraneal 7.5%, i Physioneal 1.36%, i and Physioneal 2.27% i ) has been reported before (15,16), while the stability of PIP/TZB has been investigated in 2 types of PD solutions (Dianeal 1.5% i and Dianeal 4.25% i ) (17). Beyond these studies, the stability of meropenem and PIP/TZB in other types of PD solution is unknown.…”

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confidence: 96%