[Transperitoneal resorption of cefotiam in CAPD patients with and without peritonitis].

BACKGROUND

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.

PATIENTS AND METHODS

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.

RESULTS

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.

CONCLUSION

Using the regimen described, cefotiam is an effective and safe first-line antibiotic for the treatment of CAPD-related peritonitis.