Review of Antibiotic Dosing with Peritonitis in APD

Mancini, Ann; Piraino, Beth

doi:10.3747/pdi.2018.00209

Cited by 10 publications

(9 citation statements)

References 43 publications

(55 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In some circumstances, switching APD patients to CAPD may ensure adequate levels of antibiotics. 21 In addition, if antibiotics need to be given continuously, APD will need to be switched to CAPD. In our center, we switch APD patients with ampicillin-sensitive Enterococcus peritonitis to CAPD to facilitate ampicillin dosing, which must be dosed continuously.…”

Section: We Do Not Dose and Choose Antibiotics Correctlymentioning

confidence: 99%

Peritoneal Dialysis–Associated Peritonitis: Suggestions for Management and Mistakes to Avoid

2020

View full text Add to dashboard Cite

Peritonitis is a common complication of peritoneal dialysis that is associated with substantial morbidity and mortality. Peritonitis increases treatment costs and hospitalization events and is the most common reason for transfer to hemodialysis. Although there is much focus on preventing peritoneal dialysis–associated peritonitis, equally as important is appropriate management to minimize the morbidity of a peritonitis episode when it has occurred. Despite the presence of international guidelines on peritonitis treatment, the evidence base to support optimal peritonitis treatment practices is lacking, leaving the practitioner to rely on clinical experience and extrapolate from across other infection treatment practices. This article reviews common mistakes and misconceptions that we have observed in the management of peritonitis that may compromise treatment success. It also provides suggestions on common controversial aspects of peritonitis management based on the best available literature. Although the use of the word mistakes is somewhat controversial and subjective, we acknowledge that evidence is lacking and have based many of our suggestions on clinical judgment, experience, and available data.

show abstract

Section: We Do Not Dose and Choose Antibiotics Correctlymentioning

confidence: 99%

Peritoneal Dialysis–Associated Peritonitis: Suggestions for Management and Mistakes to Avoid

2020

View full text Add to dashboard Cite

show abstract

“…Apart from the antibiotics discussed in the recent review by Mancini and Piraino 7 for empirical treatment of APD-associated peritonitis, only cefepime and meropenem have pharmacokinetic data available for IP administration in patients on APD, as presented in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…The inclusion criteria were defined as follows: pharmacokinetic studies, case series or case reports on antibiotics on ISPD recommendations not covered by Mancini and Piraino, 7 and administered via the IP route for APD-associated peritonitis in adult patients ≥18 years old or pharmacokinetic studies of IP antibiotics in adults on APD. Table 1 summarises the variables of the included studies.…”

Section: Methodsmentioning

confidence: 99%

“…Mancini and Piraino 7 have reviewed the pharmacokinetic data on common antibiotics for the empirical treatment of peritonitis in patients on APD, including first- and third-generation cephalosporins, vancomycin and gentamicin. This study provides information on the pharmacokinetics of other IP antibiotics that could be used for both empirical and culture-directed management of peritonitis in patients on APD as per ISPD recommendations.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pharmacokinetics of culture-directed antibiotics for the treatment of peritonitis in automated peritoneal dialysis: A systematic narrative review

et al. 2021

View full text Add to dashboard Cite

The objectives of this study were to provide a summary of the pharmacokinetic data of some intraperitoneal (IP) antibiotics that could be used for both empirical and culture-directed therapy, as per the ISPD recommendations, and examine factors to consider when using IP antibiotics for the management of automated peritoneal dialysis (APD)-associated peritonitis. A literature search of PubMed, EMBASE, Scopus, MEDLINE and Google Scholar for articles published between 1998 and 2020 was conducted. To be eligible, articles had to describe the use of antibiotics via the IP route in adult patients ≥18 years old on APD in the context of pharmacokinetic studies or case reports/series. Articles describing the use of IP antibiotics that had been recently reviewed (cefazolin, vancomycin, gentamicin and ceftazidime) or administered for non-APD-associated peritonitis were excluded. A total of 1119 articles were identified, of which 983 abstracts were screened. Seventy-three full-text articles were assessed for eligibility. Eight records were included in the final study. Three reports had pharmacokinetic data in patients on APD without peritonitis. Each of cefepime 15 mg/kg IP, meropenem 0.5 g IP and fosfomycin 4 g IP given in single doses achieved drug plasma concentrations above the minimum inhibitory concentration for treating the susceptible organisms. The remaining five records were case series or reports in patients on APD with peritonitis. While pharmacokinetic data support intermittent cefepime 15 mg/kg IP daily, only meropenem 0.5 g IP and fosfomycin 4 g IP are likely to be effective if given in APD exchanges with dwell times of 15 h. Higher doses may be required in APD with shorter dwell times. Information on therapeutic efficacy was derived from case reports/series in individual patients and without therapeutic drug monitoring. Until more pharmacokinetic data are available on these antibiotics, it would be prudent to shift patients who develop peritonitis on APD to continuous ambulatory peritoneal dialysis, where pharmacokinetic information is more readily available.

show abstract

“…Peritoneal inflammation affects IP drug PK, and the absorption is increased during peritonitis possibly leading to increased systemic concentrations. 10…”

Section: Discussionmentioning

confidence: 99%

Intraperitoneal vancomycin for peritoneal dialysis-associated peritonitis in children: Evaluation of loading dose guidelines

et al. 2020

View full text Add to dashboard Cite

Background: Current pediatric International Society for Peritoneal Dialysis guidelines for initial treatment of peritoneal dialysis (PD)-associated peritonitis suggest either monotherapy with cefepime or double therapy with first-generation cephalosporin or glycopeptide and ceftazidime or aminoglycoside. When using vancomycin, the intraperitoneal (IP) recommended pediatric loading dosage is 1000 mg/L of dialysate. This is based on adult pharmacokinetic (PK) studies and roughly translates to the adult recommendation where 30 mg/kg in 2 L is approximately 1000 mg/L. However, since the dialysate volume in pediatric patients is normalized to body surface area and not weight, the current recommended dosing can result in high vancomycin exposure in children. Vancomycin can potentially cause adverse effects. We aimed to determine if the IP vancomycin dosing of 1000 mg/L was causing elevated vancomycin levels and to offer possible dosing recommendations based on PK modeling and simulation. Methods: Retrospective review of pediatric patients who had been treated with IP vancomycin for PD-associated peritonitis. Vancomycin levels obtained for clinical monitoring were analyzed using NONMEM to generate population and individual (empiric Bayesian) estimates of vancomycin PK parameters and estimated peak levels. Predicted vancomycin peaks were also simulated from virtual pediatrics patients 3–70 kg following various dosing strategies. Results: Six episodes of peritonitis in three patients were analyzed. In the two episodes treated with 1000 mg/L, the first vancomycin levels (h post) were 95.6 ug/mL (3) and 49 (33) and following 500 mg/L were 33.2 (11), 30.2 (11), 23.6 (24), and 22.1 (11). All patients were cured of their peritonitis without the need for catheter removal. Based on our population PK model, a 1000 mg/L IP vancomycin loading dose will typically result in peak > 50 mg/L in patients weighing <35 kg and >60 mg/L in patients <15 kg. Vancomycin levels will remain above 20 mg/L for over 2 days without additional vancomycin dosing. Conclusion: The data suggest that a loading dose of vancomycin 1000 mg/L leads to higher than desired vancomycin levels and should be lowered. A 500 mg/L loading dosing appears more appropriate and needs further study.

show abstract

Review of Antibiotic Dosing with Peritonitis in APD

Cited by 10 publications

References 43 publications

Peritoneal Dialysis–Associated Peritonitis: Suggestions for Management and Mistakes to Avoid

Peritoneal Dialysis–Associated Peritonitis: Suggestions for Management and Mistakes to Avoid

Pharmacokinetics of culture-directed antibiotics for the treatment of peritonitis in automated peritoneal dialysis: A systematic narrative review

Intraperitoneal vancomycin for peritoneal dialysis-associated peritonitis in children: Evaluation of loading dose guidelines

Contact Info

Product

Resources

About