Thomae U, Koblinger S
VI. Medizinische Abteilung des Städtischen Krankenhauses München-Schwabing.
Med Klin (Munich). 1994 Sep 15;89(9):464-8.
Cephalosporins of the second generation have been repeatedly recommended for the treatment of peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD), because they are effective against most of the clinically relevant bacteria. In this study, we tested cefotiam, a member of this group of antibiotics, for its suitability in this indication, and determined the intraperitoneal dosage needed to achieve effective serum levels.
IN 10 CAPD-patients with and 10 without peritonitis, cefotiam was added to the dialysis bags (2 l) over a period of seven days. Prior to initiating antibiotic treatment, a sample of dialysis fluid was submitted to bacteriological and cytological examination. During the treatment period, the bags were changed four times a day. In the first three patients 0.5 g cefotiam/bag was administered. Two to four days after initiating treatment, these patients developed nausea and occasional vomiting. Thereupon, all the other patients were given a dose of 0.5 cefotiam/bag only on the first day--a loading dose--followed by 0.25 g/bag for the next six days. Samples of blood and dialysate were obtained after 24, 48, 72, 96, 120, 144 and 168 hours. The cefotiam concentration was determined by the agar diffusion technique. Side effects were checked by clinical observation and measurement of GOT, GOP, alkaline phosphatase, gamma GT, Na, K, and creatinine together with a blood count at the beginning and end of the trial.
Among the peritonitis patients, Staphylococcus epidermidis and Staphylococcus pyogenes aureus were each found in four, and Pseudomonas aeruginosa in two patients. In all patients effective serum levels were reached after one day of treatment. In the following period, these levels were maintained. Serum concentrations were higher in patients with than in those without peritonitis (18 to 21 micrograms/ml and 11 to 16 micrograms/ml, respectively). The first three patients had toxic cefotiam levels of about 30 micrograms/ml. All the cases of staphylococcus-induced peritonitis were cured with this therapeutic regimen, while those with Pseudomonas aeruginosa peritonitis required additional treatment with tobramycin. Neither clinical nor chemical side effects were observed.
Using the regimen described, cefotiam is an effective and safe first-line antibiotic for the treatment of CAPD-related peritonitis.
第二代头孢菌素多次被推荐用于治疗与持续性非卧床腹膜透析（CAPD）相关的腹膜炎，因为它们对大多数临床相关细菌有效。在本研究中，我们测试了该组抗生素中的头孢替安在该适应症中的适用性，并确定了达到有效血清水平所需的腹腔内剂量。
在10例有腹膜炎和10例无腹膜炎的CAPD患者中，在七天的时间里将头孢替安加入透析袋（2升）中。在开始抗生素治疗前，将一份透析液样本送去进行细菌学和细胞学检查。在治疗期间，透析袋每天更换4次。在前3例患者中，每袋给予0.5克头孢替安。开始治疗后2至4天，这些患者出现恶心和偶尔呕吐。于是，所有其他患者仅在第一天给予0.5克/袋的剂量——负荷剂量——随后在接下来的6天中给予0.25克/袋。在24、48、72、96、120、144和168小时后采集血液和透析液样本。通过琼脂扩散技术测定头孢替安浓度。通过临床观察以及在试验开始和结束时测量谷草转氨酶、谷丙转氨酶、碱性磷酸酶、γ-谷氨酰转肽酶、钠、钾和肌酐以及进行血常规检查来检查副作用。
在腹膜炎患者中，分别有4例发现表皮葡萄球菌和化脓性金黄色葡萄球菌，2例发现铜绿假单胞菌。在所有患者中，治疗一天后达到有效血清水平。在随后的时期，这些水平得以维持。有腹膜炎的患者血清浓度高于无腹膜炎的患者（分别为18至21微克/毫升和11至16微克/毫升）。前3例患者头孢替安的毒性水平约为30微克/毫升。所有葡萄球菌引起的腹膜炎病例均通过该治疗方案治愈，而铜绿假单胞菌腹膜炎患者需要加用妥布霉素进行额外治疗。未观察到临床或化学副作用。
采用所述方案，头孢替安是治疗与CAPD相关腹膜炎的一种有效且安全的一线抗生素。
