title: Short-Dwell Cycling Intraperitoneal Cefazolin Plus Ceftazidime in Peritoneal Dialysis Patients.
abstract: ♦ BACKGROUND: Current guidelines suggest that intraperitoneal (IP) antibiotics should be administered only in a long peritoneal dialysis (PD) dwell (≥ 6 hours). The long dwell might result in low ultrafiltration and volume overload. We aim to examine plasma and dialysate concentration of cefazolin and ceftazidime after IP administration in a short-dwell (≤ 2 hours) automated cycling exchange. ♦ METHODS: Stable PD patients without peritonitis were invited to participate in the present study. Patients underwent 5 2-liter exchanges of PD fluid over 10 hours by the PD cycling machine without last fill or additional dwell. Cefazolin and ceftazidime (20 mg/kg each) were added to the first 5-liter bag of 2.5% dextrose PD fluid that was placed on the warmer of the PD cycling machine. Plasma samples were collected at 12 time-points over 24 hours. Dialysate samples from each exchange were also collected. Antibiotic concentrations in plasma and dialysate were then determined by high-performance liquid chromatography (HPLC). ♦ RESULTS: Six stable PD patients without peritonitis participated in the study. Dialysate cefazolin and ceftazidime were consistently high throughout the PD session in all patients (26 - 360 mg/L). Plasma cefazolin and ceftazidime exceeded the minimal inhibitory concentration (MIC) for susceptible organisms (≤ 8 mg/L) within 2 hours (cefazolin 28.5 ± 8.0 and ceftazidime 12.5 ± 3.4 mg/L), peak at 10 hours (51.1 ± 14.1 and 23.0 ± 5.2 mg/L) and sustained well above the MIC at 24 hours (42.0 ± 9.6 and 17.1 ± 3.1 mg/L). ♦ CONCLUSIONS: The short-dwell cycling IP cefazolin and ceftazidime could provide adequate plasma concentration for up to 24 hours. Daily short-dwell cycling IP cefazolin and ceftazidime might be used to treat peritonitis in PD patients already using a PD cycling machine as well as selected continuous ambulatory PD (CAPD) patients who need shorter dwells during peritonitis due to increasing peritoneal solute transport.
authors.affiliation: Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Sadudee
authors.initials: S
authors.lastname: Peerapornratana
authors.affiliation: Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Pajaree
authors.initials: P
authors.lastname: Chariyavilaskul
authors.affiliation: Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.|Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital and Kidney and Metabolic Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Talerngsak
authors.initials: T
authors.lastname: Kanjanabuch
authors.affiliation: Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Kearkiat
authors.initials: K
authors.lastname: Praditpornsilpa
authors.affiliation: Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Somchai
authors.initials: S
authors.lastname: Eiam-Ong
authors.affiliation: Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand pkatavetin@yahoo.com.
authors.forename: Pisut
authors.initials: P
authors.lastname: Katavetin
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics; D001331:Automation; D001682:Biological Availability; D002437:Cefazolin / Q000008:administration & dosage / Q000493:pharmacokinetics*; D002442:Ceftazidime / Q000008:administration & dosage / Q000493:pharmacokinetics*; D015331:Cohort Studies; D015314:Dialysis Solutions / Q000008:administration & dosage* / Q000493:pharmacokinetics; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007274:Injections, Intraperitoneal; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D011379:Prognosis; D013785:Thailand; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015314:Dialysis Solutions; D002442:Ceftazidime; D002437:Cefazolin
keywords: Cefazolin; ceftazidime; cycler; intraperitoneal; peritoneal dialysis; regimen