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Peritoneal fluid concentrations of gentamicin in patients with spontaneous bacterial peritonitis
Abstract:
Simultaneous peritoneal fluid and serum gentamicin assays were performed at 1- or 4-h intervals after the intravenous administration of gentamicin (3 to 5 mg/kg per day) during nine episodes of spontaneous bacterial peritonitis in cirrhotic patients. Mean peritoneal fluid levels were 4.2 micrograms/ml, whereas simultaneous mean serum levels were 6.1 micrograms/ml (mean percent diffusion into ascites of 67.8%). Three additional patients with uninflamed ascites demonstrated lower levels of diffusion. Regression analysis revealed a positive correlation between simultaneous serum and peritoneal fluid levels. We conclude that diffusion of gentamicin from serum into peritoneal fluid during spontaneous peritonitis is therapeutically adequate if sufficient serum levels are maintained.
Insights
Gentamicin effectively diffuses into peritoneal fluid during spontaneous bacterial peritonitis in cirrhotic patients. Maintaining adequate serum gentamicin levels ensures therapeutic concentrations in ascites.
Area of Science:
- Pharmacology
- Infectious Diseases
- Hepatology
Background:
- Spontaneous bacterial peritonitis (SBP) is a serious complication in cirrhotic patients.
- Optimal antibiotic penetration into ascitic fluid is crucial for effective SBP treatment.
- Gentamicin is a commonly used antibiotic for SBP, but its peritoneal fluid levels require investigation.
Purpose of the Study:
- To assess gentamicin concentrations in peritoneal fluid and serum in cirrhotic patients with SBP.
- To determine the extent of gentamicin diffusion into ascitic fluid.
- To evaluate the correlation between serum and peritoneal fluid gentamicin levels.
Main Methods:
- Intravenous gentamicin administration (3-5 mg/kg/day) in nine cirrhotic patients with SBP.
- Simultaneous peritoneal fluid and serum gentamicin assays at 1- or 4-hour intervals.
- Comparison of diffusion in patients with inflamed versus uninflamed ascites.
Main Results:
- Mean peritoneal fluid gentamicin level was 4.2 µg/ml; mean serum level was 6.1 µg/ml.
- Average gentamicin diffusion into ascitic fluid was 67.8%.
- Lower diffusion rates were observed in patients with uninflamed ascites; a positive correlation between serum and fluid levels was found.
Conclusions:
- Gentamicin diffusion into peritoneal fluid during SBP is therapeutically adequate.
- Sufficient serum gentamicin concentrations are key to achieving effective peritoneal fluid levels.
- This study supports the use of gentamicin for SBP when adequate serum levels are maintained.