Related Experiment Videos
[Treatment of peritonitis under continuous ambulatory peritoneal dialysis using intraperitoneal ceftazidime]
J M Ragnaud1, M Dupon, P Morlat
1Clinique Médicale et des Maladies Infectieuses, Hôpital Pellegrin-Tripode, Bordeaux.
Abstract:
Management of peritonitis related to chronic ambulatory peritoneal ceftazidime. In 15 patients under CAPD, 22 cases of bacterial peritonitis were observed with clinical manifestation in 14. The mean cell count in peritoneal dialysis fluid was 3 580/mm3 with 3 040/mm3 polymorphonuclear leukocytes. Causative pathogens were: Staphylococcus in 11 cases, Streptococcus in 3, Sarcines in 2, Corynebacterium in 2, Micrococcus varians in 1, Gram negative in 3. First choice treatment was a intraperitoneal injection of 1 g of ceftazidime every 48 hours, 54.5% of patients recovered within 5 days. Failures were due to 4 Staphylococcus aureus, 3 Staphylococcus epidermidis, 1 Sarcine, 1 Streptococcus liquefaciens, 1 Corynebacterium hofmanii. Mean ceftazidime concentrations 48 hours after the intraperitoneal injection were 35 mg/l (range = 14-54 mg/l) in serum and 5.5 mg/l (E: 2.8,8 mg/l) in dialysate. These concentrations in dialysate, are not greater than most of ceftazidime'S CMI for susceptible bacteria. A single daily intraperitoneal injection of ceftazidime is desirable.
Insights
Ceftazidime administered every 48 hours for bacterial peritonitis in chronic ambulatory peritoneal dialysis (CAPD) patients showed limited efficacy. A daily intraperitoneal ceftazidime injection may improve treatment outcomes for CAPD-related peritonitis.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Context:
- Chronic ambulatory peritoneal dialysis (CAPD) is a common treatment for end-stage renal disease.
- Bacterial peritonitis is a serious complication of CAPD, requiring effective antibiotic management.
- Ceftazidime is an antibiotic used to treat bacterial infections.
Purpose:
- To evaluate the efficacy of ceftazidime administered intraperitoneally every 48 hours for managing bacterial peritonitis in CAPD patients.
- To determine the pharmacokinetic profile of ceftazidime in serum and dialysate following intraperitoneal administration.
- To identify factors contributing to treatment failure.
Summary:
- Twenty-two cases of bacterial peritonitis were observed in 15 CAPD patients.
- Common pathogens included Staphylococcus, Streptococcus, and Gram-negative bacteria.
- Treatment with intraperitoneal ceftazidime (1g every 48 hours) resulted in a 54.5% recovery rate within 5 days.
- Treatment failures were associated with specific bacterial species, including Staphylococcus aureus and Staphylococcus epidermidis.
- Mean serum ceftazidime concentrations were 35 mg/l and dialysate concentrations were 5.5 mg/l at 48 hours.
- Dialysate concentrations were below the minimum inhibitory concentrations (MICs) for susceptible bacteria, suggesting suboptimal dosing.
Impact:
- The study suggests that the current dosing regimen of ceftazidime every 48 hours may be insufficient for effective peritonitis treatment in CAPD patients.
- Results indicate a need for optimized dosing strategies, such as a single daily intraperitoneal injection, to achieve therapeutic concentrations in the peritoneal fluid.
- Findings contribute to improving antibiotic management protocols for CAPD-related peritonitis, potentially reducing treatment failures and improving patient outcomes.