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Dialysate and plasma meropenem concentrations in continuous intraperitoneal regimen during
Thatsaphan Srithongkul1, Sukit Raksasuk1, Bulaporn Techajongnumchai1
1Division of Nephrology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Background:
A single dose of intraperitoneal (IP) meropenem is recommended for peritoneal-dialysis (PD)-related peritonitis stemming from extended-spectrum β-lactamase-producing organisms. However, data on IP meropenem is limited.
Methods:
This prospective, descriptive study was conducted to examine plasma and dialysate meropenem levels during continuous IP meropenem administration in five patients with PD-related peritonitis. All patients received an IP meropenem loading dose of 500 mg, followed by IP meropenem at 125 mg/L, with four exchanges daily. The plasma and dialysate meropenem concentrations were measured at specified intervals for a 24-hour period utilizing a high-performance, liquid chromatography method.
Results:
Five patients with PD related peritonitis were studied. The mean-maximum dialysate and plasma meropenem levels were 158.1 mg/L (standard deviation [SD] ± 62.9) and 29.4 mg/L (SD ± 15.9), respectively. The mean dialysate meropenem level was at its minimum of 32.6 mg/L (SD ± 19.1) at 24 hours. Throughout the period, the dialysate meropenem levels exceeded the minimal inhibitory concentration of the pathogenic resistance organism (> 8 mg/L). Four patients responded to the treatment, whereas one developed treatment failure from fungal peritonitis.
Conclusion:
An IP meropenem loading of 500 mg, followed by 125 mg/L every 6 hours, provided an adequate dialysate meropenem concentration and is an effective treatment for PD related peritonitis.
Trial Registration:
Thai Clinical Trials Registry (TCTR20191121002) with date of first registration at 21/11/2019 (retrospectively registered).
Insights
Intraperitoneal meropenem effectively treats peritoneal dialysis-related peritonitis by maintaining adequate dialysate concentrations. This study evaluated meropenem levels in patients with peritonitis, confirming its therapeutic potential.
Area of Science:
- Pharmacology
- Nephrology
- Infectious Diseases
Background:
- Intraperitoneal (IP) meropenem is recommended for peritoneal dialysis (PD)-related peritonitis caused by extended-spectrum β-lactamase-producing organisms.
- Limited data exists on the pharmacokinetics of IP meropenem in PD patients.
Purpose of the Study:
- To examine plasma and dialysate meropenem levels during continuous IP meropenem administration in patients with PD-related peritonitis.
- To assess the efficacy of IP meropenem for treating PD-related peritonitis.
Main Methods:
- Prospective, descriptive study involving five patients with PD-related peritonitis.
- Patients received an IP meropenem loading dose (500 mg) followed by 125 mg/L with four daily exchanges.
- Plasma and dialysate meropenem concentrations were measured over 24 hours using high-performance liquid chromatography.
Main Results:
- Mean peak dialysate meropenem level was 158.1 mg/L; mean peak plasma level was 29.4 mg/L.
- Mean minimum dialysate level at 24 hours was 32.6 mg/L, consistently exceeding the minimum inhibitory concentration (> 8 mg/L).
- Four out of five patients responded to treatment; one experienced treatment failure due to fungal peritonitis.
Conclusions:
- A loading dose of 500 mg IP meropenem followed by 125 mg/L every 6 hours ensures adequate dialysate concentrations.
- This regimen is effective for treating PD-related peritonitis caused by susceptible organisms.
