Pharmacokinetics of Intraperitoneal Cefotaxime Treatment of Peritonitis in Patients on Continous Ambulatory Peritoneal Dialysis

Abstract

The pharmacokinetics of intraperitoneal cefotaxime as the sole therapy in patients on continous ambulatory peritoneal dialysis with peritonitis have been examined. The mean plasma concentrations achieved following 1 h of peritoneal instillation of 500 mg of cefotaximine were 5.0 ± 1.6 μg ml^-1. The average plasma concentration over 24 h was 6.9 ± 0.4 μg ml^-1 and was no different from that found following a further 9-11 days of successful treatment of the peritonitis. However, the mean dialysate effluent concentration of cefotaxime was increased following the resolution of the peritonitis, 165 ± 22.7 mg per cycle on day 10 or 12 compared with 50.4 ± 7.3 mg per cycle on day 1, suggesting enhanced peritoneal cefotaxime absorption during acute peritonitis. Nevertheless, during both periods, adequate concentrations of cefotaxime were achieved in dialysate to treat local complications, but plasma levels may be inadequate to treat systemic complications due to Staphylococcus albus.

Pharmacokinetics of imipenem-cilastatin in patients with renal insufficiency undergoing continuous ambulatory peritoneal dialysis

“…Patients with ESRD undergoing hemodialysis are quite different from those undergoing CAPD since in the former a highly dialyzable drug is removed extensively during hemodialysis, and after completion of the procedure, a supplemental dose may be necessary to reestablish therapeutic drug levels, whereas in patients on CAPD, a continuous exchange of drug may occur throughout the 24-h period and the drug excretion via this route would depend on the rate of transperitoneal movement and the number of exchanges per day. Results of previous investigations (1,4,11,17) with single drugs showed that some drugs such as gentamicin (22), tobramycin ( (13) are poorly eliminated by PD although they are rapidly absorbed when given i.p. However, only 3 to 10% of the highly dialyzable drugs (e.g., ceftizoxime) are eliminated by this route (9,10).…”