Triyawatanyu Pinpongsarn, Chariyavilaskul Pajaree, Phaisal Weeraya, Peerapornratana Sadudee, Kanjanabuch Talerngsak, Praditpornsilpa Kearkiat, Katavetin Pisut
Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Clinical Pharmacokinetics and Pharmacogenomics Research Unit, Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Perit Dial Int. 2020 Mar;40(2):179-184. doi: 10.1177/0896860819893820. Epub 2020 Jan 17.
Intraperitoneal (IP) cefazolin and ceftazidime during the short-dwell (≤ 2 h) automated exchange has been shown to provide adequate dialysate and plasma concentrations for up to 24 h in peritoneal dialysis (PD) patients without peritonitis. This study aimed to evaluate plasma and dialysate concentration of this novel IP cefazolin and ceftazidime regimen during the first 24 h in PD patients with peritonitis.
Cefazolin and ceftazidime (2500 mg each) were added to in to a 5-L bag containing 2.5% of dextrose PD fluid which was placed on the warmer of PD cycling machine. Patients underwent five exchanges of 2-L PD fluid over 10 h by the PD cycling machine without last fill or additional dwell. Plasma samples and dialysate samples were collected over 24 h. Cefazolin and ceftazidime concentrations in plasma and dialysate were determined by high-performance liquid chromatography.
Seven PD patients with peritonitis participated in this study. Plasma cefazolin and ceftazidime levels increased substantially within the first few hours, peaked around 6-10 h, and sustained well above the target plasma concentrations (10 mg L for cefazolin and 16 mg L for ceftazidime) until 24 h. Dialysate cefazolin and ceftazidime levels were sustained above the target peritoneal concentrations (2 mg L for cefazolin and 8 mg L for ceftazidime) throughout the PD session except in some samples which the antibiotics levels were unusually low, probably from beta-lactamase activity.
IP cefazolin and ceftazidime during the short-dwell automated exchange could provide adequate dialysate and plasma concentrations in peritonitis patients. This novel regimen is a promising regimen for peritonitis in PD patients.
在短驻留（≤2小时）自动腹膜透析期间腹腔内（IP）给予头孢唑林和头孢他啶已被证明可为无腹膜炎的腹膜透析（PD）患者提供长达24小时的足够透析液和血浆浓度。本研究旨在评估这种新型IP头孢唑林和头孢他啶方案在PD腹膜炎患者最初24小时内的血浆和透析液浓度。
将头孢唑林和头孢他啶（各2500毫克）加入一个装有2.5%葡萄糖腹膜透析液的5升袋中，该袋置于腹膜透析循环机的加热器上。患者通过腹膜透析循环机在10小时内进行5次2升腹膜透析液交换，无末次填充或额外驻留。在24小时内采集血浆样本和透析液样本。采用高效液相色谱法测定血浆和透析液中头孢唑林和头孢他啶的浓度。
7例PD腹膜炎患者参与了本研究。血浆中头孢唑林和头孢他啶水平在最初几小时内大幅升高，在6 - 10小时左右达到峰值，并在24小时内持续远高于目标血浆浓度（头孢唑林为10毫克/升，头孢他啶为16毫克/升）。除了一些抗生素水平异常低（可能由于β-内酰胺酶活性）的样本外，在整个腹膜透析过程中，透析液中头孢唑林和头孢他啶水平持续高于目标腹膜浓度（头孢唑林为2毫克/升，头孢他啶为8毫克/升）。
短驻留自动腹膜透析期间腹腔内给予头孢唑林和头孢他啶可为腹膜炎患者提供足够的透析液和血浆浓度。这种新型方案是PD患者腹膜炎的一种有前景的治疗方案。
