Treatment of peritonitis in APD: pharmacokinetic principles
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Updated: Sep 28, 2026

An Intestine/Liver Microphysiological System for Drug Pharmacokinetic and Toxicological Assessment
Published on: December 3, 2020
Harold J Manley1, George R Bailie
1University of Missouri - Kansas City, School of Pharmacy, Kansas City, Missouri 64108, USA. ManleyH@UMKC.edu
Abstract:
Clinicians treating peritoneal dialysis (PD)-associated peritonitis should be aware that continuous ambulatory PD (CAPD) and automated PD (APD) have different effects on the pharmacokinetics of antibiotics. Results from various APD and comparative CAPD pharmacokinetic studies are reviewed. In APD patients, antibiotic half-lives were shorter during the cycler exchanges. Antibiotic peritoneal clearance was greater in patients treated with APD than those treated with CAPD regimens. Antibiotic clearance depends upon residual renal function and dialysate flow rate. To ensure that maximal antibiotic bioavailability occurs with intermittent intraperitoneal (IP) dosing, it is recommended that the antibiotic-containing dialysate must dwell at least 4 hours to ensure an adequate antibiotic depot in the body. Knowledge of antibiotic disposition in PD patients will assist clinicians in appropriate IP antibiotic dose selection and prevention of dose-related adverse effects.
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