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Shemin D, Maaz D. Gram-Negative Peritonitis in Peritoneal Dialysis: Improved Outcome with Intraperitoneal Ceftazidime. Perit Dial Int 2020. [DOI: 10.1177/089686089601600617] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Douglas Shemin
- Renal Division, Department of Medicine Rhode Island Hospital Brown University School of Medicine Providence
- Rhode Island Renal Institute Warwick, Rhode Island, U.S.A
| | - Donna Maaz
- Rhode Island Renal Institute Warwick, Rhode Island, U.S.A
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Yeung SM, Walker SE, Tailor SA, Awdishu L, Tobe S, Yassa T. Pharmacokinetics of Oral Ciprofloxacin in Continuous Cycling Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080402400509] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BackgroundIn order to avoid aminoglycosides, the International Society for Peritoneal Dialysis recommends cefazolin and ceftazidime for empirical treatment of peritonitis. Ciprofloxacin covers relevant gram-negative pathogens without the resistance associated with ceftazidime. However, ciprofloxacin pharmacokinetic data in patients on continuous cycling peritoneal dialysis (CCPD) are lacking.Objectives( 1 ) To determine the pharmacokinetics of oral ciprofloxacin in CCPD patients, ( 2 ) to compare serum and dialysate ciprofloxacin concentrations with minimum inhibitory concentrations (MIC) of the gram-negative bacteria associated with peritonitis, and ( 3 ) to establish oral ciprofloxacin dosing guidelines for the empirical treatment of peritonitis in patients receiving CCPD.MethodsEligible CCPD patients received 2 doses of ciprofloxacin: 750 mg orally every 12 hours. Serial blood and end-of-dwell dialysate samples were collected during the first 12-hour interval; an end-of-dwell dialysate sample from the overnight dwell and a final blood sample were collected at the end of the second 12-hour interval. Ciprofloxacin concentrations were determined using a liquid chromatographic (HPLC)-fluorescence method. Pharmacokinetic calculations were completed assuming a one-compartment model.ResultsEight patients completed the study. The pharmacokinetic parameters determined for ciprofloxacin were (mean ± SEM) serum half-life 10.1 ± 1.2 hours, maximum serum concentration 2.7 ± 0.5 mg/L, time to maximum serum concentration 1.6 ± 0.1 hours after the first dose, and peritoneal clearance 1.2% ± 0.1% of the mean calculated total body clearance. While all patients achieved serum area under the concentration-time curve: MIC > 125 for Escherichia coli and Klebsiella species after the first dose, only 2 patients achieved this goal for Pseudomonas aeruginosa. End-of-dwell dialysate concentrations were above the MIC for E. coli, Klebsiella spp, and P. aeruginosa after the second dose.ConclusionCiprofloxacin 750 mg orally every 12 hours in CCPD patients may be useful for empirical gram-negative coverage of CCPD peritonitis and for treatment of documented peritonitis caused by sensitive E. coli or Klebsiella species. While ceftazidime may be required for documented pseudomonal peritonitis, the oral ciprofloxacin regimen achieved adequate serum concentrations to treat systemic gram-negative infections caused by sensitive E. coli or Klebsiella species.
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Affiliation(s)
- Sharon M. Yeung
- Department of Pharmacy, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, Canada
| | - Scott E. Walker
- Department of Pharmacy, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, Canada
| | - Sandra A.N. Tailor
- Department of Pharmacy, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, Canada
- Divisions of Infectious Diseases, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, Canada
| | - Linda Awdishu
- Department of Pharmacy, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, Canada
- Nephrology, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, Canada
| | - Sheldon Tobe
- Nephrology, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, Canada
| | - Teraiza Yassa
- Nephrology, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, Canada
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Lima RC, Barreira A, Cardoso FL, Lima MH, Leite M. Ciprofloxacin and Cefazolin as a Combination for Empirical Initial Therapy of Peritoneal Dialysis-Related Peritonitis: Five-year Follow-up. Perit Dial Int 2020. [DOI: 10.1177/089686080702700113] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The treatment of peritoneal dialysis (PD)-related peritonitis has been a matter of extensive investigation, frequently generating therapeutic trials. Several combinations of antibiotics have served as newer protocols and tended to be efficacious, comfortable, and cost-effective. According to the more recent recommendations from the International Society for Peritoneal Dialysis, the rationale for empirical initial therapy of clinically detected peritonitis in PD patients has been to follow the bacterial profile derived from cultured specimens of PD effluents.The current study describes 5 year's experience with the use of a new antibiotic regimen for the treatment of peritonitis. We herein analyze the outcome of 95 episodes of peritonitis in 54 patients on either automated PD or continuous ambulatory PD at the dialysis unit of the Federal University of Rio de Janeiro. Peritoneal dialysis-related peritonitis was treated with the combination of oral ciprofloxacin and intraperitoneal cefazolin. The observed cure rate was 85.2% and the sensitivity test was observed to be positive for this combination of antibiotics in 88.9% of positive cultures. Of the 14 unsuccessful episodes, 7 were due to catheter colonization and the rest did not respond to the proposed therapy within 48 hours. These 7 cases were also related to peritoneal fluid cultures that were resistant to both ciprofloxacin and cefazolin.From this study, we propose this combination of oral ciprofloxacin and intraperitoneal cefazolin as a first choice for empirical initial therapy of PD-related peritonitis, given its efficacy and low cost. However, in order to apply the most adequate cost-effective therapy, careful examination of the bacterial profile and sensitivities to antibiotics used in each unit is strongly recommended.
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Affiliation(s)
- Renata C.S. Lima
- Division of Nephrology Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - André Barreira
- Division of Nephrology Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando L. Cardoso
- Department of Infectious Disease, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcio H.S. Lima
- Division of Nephrology Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maurilo Leite
- Division of Nephrology Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Pharmacokinetic Study of Antimicrobial Agents in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis. J Infect Chemother 1996. [DOI: 10.1007/bf02351570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Barretti P, Bignardi J, Soares V. Successful Treatment of Peritonitis in Ipd with Oral Fluoroquinolone. Perit Dial Int 1994. [DOI: 10.1177/089686089401400226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- P. Barretti
- Botucatu Medical School Department of Internal Medicine Division of Nephrology Botucatu, SP, Brazil
| | - J.H. Bignardi
- Botucatu Medical School Department of Internal Medicine Division of Nephrology Botucatu, SP, Brazil
| | - V.A. Soares
- Botucatu Medical School Department of Internal Medicine Division of Nephrology Botucatu, SP, Brazil
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