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Short-Dwell Cycling Intraperitoneal Cefazolin Plus Ceftazidime in Peritoneal Dialysis Patients.
Perit Dial Int 2017 Mar-Apr; 37(2):218-224PD

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+Show Affiliations

Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.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.Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand pkatavetin@yahoo.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27738089

Citation

Peerapornratana, Sadudee, et al. "Short-Dwell Cycling Intraperitoneal Cefazolin Plus Ceftazidime in Peritoneal Dialysis Patients." Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis, vol. 37, no. 2, 2017, pp. 218-224.
Peerapornratana S, Chariyavilaskul P, Kanjanabuch T, et al. Short-Dwell Cycling Intraperitoneal Cefazolin Plus Ceftazidime in Peritoneal Dialysis Patients. Perit Dial Int. 2017;37(2):218-224.
Peerapornratana, S., Chariyavilaskul, P., Kanjanabuch, T., Praditpornsilpa, K., Eiam-Ong, S., & Katavetin, P. (2017). Short-Dwell Cycling Intraperitoneal Cefazolin Plus Ceftazidime in Peritoneal Dialysis Patients. Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis, 37(2), pp. 218-224. doi:10.3747/pdi.2015.00300.
Peerapornratana S, et al. Short-Dwell Cycling Intraperitoneal Cefazolin Plus Ceftazidime in Peritoneal Dialysis Patients. Perit Dial Int. 2017;37(2):218-224. PubMed PMID: 27738089.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Short-Dwell Cycling Intraperitoneal Cefazolin Plus Ceftazidime in Peritoneal Dialysis Patients. AU - Peerapornratana,Sadudee, AU - Chariyavilaskul,Pajaree, AU - Kanjanabuch,Talerngsak, AU - Praditpornsilpa,Kearkiat, AU - Eiam-Ong,Somchai, AU - Katavetin,Pisut, Y1 - 2016/10/13/ PY - 2015/12/14/received PY - 2016/08/11/accepted PY - 2016/10/16/pubmed PY - 2018/1/13/medline PY - 2016/10/15/entrez KW - Cefazolin KW - ceftazidime KW - cycler KW - intraperitoneal KW - peritoneal dialysis KW - regimen SP - 218 EP - 224 JF - Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis JO - Perit Dial Int VL - 37 IS - 2 N2 - ♦ 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. SN - 1718-4304 UR - https://www.unboundmedicine.com/medline/citation/27738089/Short_Dwell_Cycling_Intraperitoneal_Cefazolin_Plus_Ceftazidime_in_Peritoneal_Dialysis_Patients_ L2 - http://www.pdiconnect.com/cgi/pmidlookup?view=long&pmid=27738089 DB - PRIME DP - Unbound Medicine ER -