Debruyne D, Ryckelynck J P, Hurault De Ligny B, Moulin M
Laboratory of Pharmacology, University Hospital Center of Caen, France.
J Pharm Sci. 1990 Feb;79(2):99-102. doi: 10.1002/jps.2600790204.
The pharmacokinetics of piperacillin given intravenously (1 or 2 g) to nine patients with chronic renal failure and undergoing continuous ambulatory peritoneal dialysis was intermediate between values obtained in healthy volunteers and in patients with renal insufficiency studied between dialyses: half-life, 2.4 h; total clearance, 100 mL/min; urinary or peritoneal clearance, 3 mL/min. The intraperitoneal administration of piperacillin in dialysis fluid (400 mg or 1 g to five patients) increased the half-life (6 to 7 h) and decreased the volume of distribution of about two thirds. In both instances, the area under the curve was well correlated with dosage. The absorption of piperacillin by an inflamed peritoneum in eight patients suffering from peritonitis and treated with 400 mg, 1 g, or 2 g, was increased and returned to normal concurrently with care. Consequently, the recommended dosage is intravenous administration of 2 g of piperacillin every 8 h or intraperitoneal administration of 1 g every 6 h in the dialysate. With such conditions, serum concentrations greater than minimal inhibitory concentrations and sufficient to avoid dissemination of piperacillin-susceptible organisms without risk of accumulation are obtained.
对9例慢性肾衰竭且正在接受持续性非卧床腹膜透析的患者静脉注射（1或2克）哌拉西林后的药代动力学情况介于健康志愿者以及透析间期研究的肾功能不全患者所获数值之间：半衰期为2.4小时；总清除率为100毫升/分钟；尿清除率或腹膜清除率为3毫升/分钟。向透析液中腹膜内给予哌拉西林（给5例患者400毫克或1克）会使半衰期延长（至6至7小时）并使分布容积减小约三分之二。在这两种情况下，曲线下面积与剂量密切相关。8例患有腹膜炎并接受400毫克、1克或2克治疗的患者，发炎的腹膜对哌拉西林的吸收增加，并在治疗过程中恢复正常。因此，推荐剂量为每8小时静脉注射2克哌拉西林，或在透析液中每6小时腹膜内给予1克。在这种情况下，可获得高于最低抑菌浓度且足以避免哌拉西林敏感菌播散且无蓄积风险的血清浓度。
