[Pharmacokinetics of gentamicin in the decompensed alcoholic cirrhotic patient. Therapeutic consequences]

Aminoglycosides and in particular gentamicin are still largely used in the treatment of spontaneous bacterial peritonitis in the decompensed alcoholic cirrhotic patient. For that matter, we decided to study the various passage of gentamicin in the ascites after its administration through IM injection (80 mg in 6 patients and 120 mg in 6 other patients) and through IV injection (120 mg in 6 other patients). What could possibly be the best protocol to replace the daily intraperitoneal injections? We found out that no matter what the style of injection is, the peritoneal levels are only exceptionnaly higher than 3 mg/g at the highest peak period. These results brought us to analyze the passage of gentamicin in the blood when injected intraperitonealy (160 mg in 6 patients), and then to propose a therapeutic protocol combining on the first day, to the peritoneal injection a loading dose of an IP injection of 160 mg, the relay been taken over later with a peritoneal injection of 80 or 120 mg repeated 2 or 3 times daily. For each of the protocol the pharmacokinetic coefficients of gentamicin were calculated.