Pharmacokinetics of Teicoplanin in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Objective

To achieve concentrations of teicoplanin in serum and dialysate within the therapeutic range in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

Design

Pharmacokinetic study.

Setting

A tertiary-care hospital.

Patients

Eight hospitalized anuric patients undergoing CAPD.

Interventions

One single dose of 10 mg/kg teicoplanin was administered intravenously, and blood and dialysate were sampled at regular time intervals for 48 hours post drug infusion. Concentrations of teicoplanin were determined by microbiological assay.

Results

Teicoplanin serum levels above 10 μg/mL, the level desired to treat systemic infections, were detected for 24 hours after administration. All dialysate concentrations were very low. Teicoplanin presented two phases of elimination: an early first phase and a late second phase. Mean maximum serum concentration was 75.56 μg/mL, mean half-life (t°) of the early elimination was 3.34 hours, mean t° of the late elimination was 61.68 hours, mean area under the serum-concentration–time curve was 1491.92 mg·hr/L, mean clearance rate was 10.68 mL/minute, mean apparent volume of distribution was 0.80 L/kg, and mean volume of distribution at steady state was 0.22 L/kg. Mean dialysate excretion was 3.16% and mean peritoneal clearance rate was 0.023 mL/minute.

Conclusions

Based on the time period with the achieved serum levels and on the prolonged t°, it is proposed that teicoplanin might be administered at 10 mg/kg every 24 hours for the therapy of systemic infections in patients undergoing CAPD. However, its intravenous administration should be avoided in the treatment of peritonitis, because the achieved dialysate concentrations were very low.

Pharmacokinetics of Moxifloxacin in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Objective

To investigate the effect of continuous ambulatory peritoneal dialysis (CAPD) on plasma and peritoneal fluid concentration and pharmacokinetics of moxifloxacin after administration of one 400 mg dose orally to end-stage renal failure patients undergoing CAPD.

Patients and Methods

Blood and peritoneal samples were collected from 8 patients at standard time intervals and concentrations of moxifloxacin were estimated by HPLC analysis with fluorometric and ultraviolet detection. Pharmacokinetic parameters were estimated using standard noncompartmental methods.

Results

Median maximum plasma moxifloxacin concentration was 5.86 mg/L at a median time of 1.25 hours. In serum, median area under the concentration–time curve (AUC0→inf) was 157.95 ± 100.34 mg·hour/L, median t½ 25.00 hours, median clearance 2.54 L/hour, and median distribution volume 94.90 L. Median peritoneal fluid-to-plasma ratio of moxifloxacin ranged between 0.84 and 1.00, denoting adequate penetration and lack of considerable moxifloxacin removal during CAPD. Maximum moxifloxacin concentration/minimum inhibitory concentration (MIC) and AUC0→24/MIC ratios were above the cutoff points that indicate clinical success.

Conclusion

A single 400 mg oral dose of moxifloxacin is safe, presents rapid peritoneal fluid penetration, has similar plasma and peritoneal fluid pharmacokinetics, and should therefore be efficacious in the treatment of CAPD-induced peritonitis.