Intraperitoneal administertion: compatibility and stability of common antibiotics in amino acid-based peritoneal...

The preferred method of antibiotic administration for peritoneal dialysis-related peritonitis is intraperitoneal. However, there are few studies on the compatibility of antibiotics in amino acid-based peritoneal dialysate.

Our study employed High Performance Liquid Chromatography (HPLC) and amino acid analyzer to evaluate the stability of different antibiotics in amino acid-based peritoneal dialysate. We also used the two-dose method to detect the antimicrobial potency of gentamicin.

Gentamicin, ciprofloxacin, heparin Sodium and fluconazole showed excellent stability under different conditions (14 days at 4 °C: ≤3.57%, 14 days at 25 °C: ≤3.77%). β-Lactam antibiotics including meropenem, ceftazidime, cefotaxime, and aztreonam showed significant degradation, especially at high temperature (37 °C)(14 days at 4 °C: ≤59.98%, 14 days at 25 °C: 19.06%-84.97%, except for aztreonam demonstrating degradation at 48 h at 37 °C (18.51%-41.88%). Among them, meropenem was the least stable (14 days at 4 °C: 59.98%, 14 days at 25 °C: 84.97%). Low concentration vancomycin is relatively stable, while medium and high concentration vancomycin has poor stability (14 days at 4 °C 500 mg/L: 45.8%, 1 g/L 27.7%). Most amino acids remained basically stable under different antibiotic environments. We counted the degradation rate of all amino acids under different conditions. The maximum degradation rate appeared on glycine, but it was only 8.21%. Finally, we also found that the antibacterial efficacy of gentamicin in acid-based peritoneal dialysate was enhanced.

Most antibiotics are stable in amino acid-based peritoneal dialysate. However, β-lactams (especially meropenem, ceftazidime, and cefotaxime) and medium-to-high dose vancomycin showed significant degradation and require prompt administration. The nutritional amino acid profile in dialysate remains largely unaffected. Gentamicin demonstrates enhanced antibacterial activity in the amino acid-based peritoneal dialysate.