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

Ling, CW, Sud, K, Van, C, Zaidi, STR, Patel, RP ORCID: 0000-0001-9344-1013, Peterson, GM ORCID: 0000-0002-6764-3882 and Castelino, RL 2021 , 'Pharmacokinetics of culture-directed antibiotics for the treatment of peritonitis in automated peritoneal dialysis: a systematic narrative review' , Peritoneal Dialysis International, vol. 41, no. 3 , pp. 261-272 , doi: 10.1177/0896860821990528.

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Abstract

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.

Item Type: Article
Authors/Creators:Ling, CW and Sud, K and Van, C and Zaidi, STR and Patel, RP and Peterson, GM and Castelino, RL
Keywords: antimicrobials, dialysis, dosage regimens, culture-directed, intraperitoneal, peritoneum permeability, peritonitis, pharmacokinetics, residual renal function, APD regimens
Journal or Publication Title: Peritoneal Dialysis International
Publisher: Multimed Inc
ISSN: 0896-8608
DOI / ID Number: 10.1177/0896860821990528
Copyright Information:

Copyright 2021 the authors

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