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Imipenem/cilastatin sodium in the treatment of continuous ambulatory peritoneal dialysis-associated peritonitis
S F Lui1, A B Cheng, C B Leung
1Department of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin.
Insights
Imipenem/cilastatin sodium effectively treats peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. Higher doses improved cure rates, showing its potential as a first-line antibiotic therapy.
Area of Science:
- Infectious Diseases
- Nephrology
- Pharmacology
Background:
- Peritonitis is a significant complication in continuous ambulatory peritoneal dialysis (CAPD).
- Thienamycin class antibiotics offer broad-spectrum bactericidal activity.
- Identifying effective single first-line therapies for CAPD peritonitis is crucial.
Purpose of the Study:
- To evaluate the efficacy of imipenem/cilastatin sodium as a single first-line treatment for CAPD peritonitis.
- To compare treatment outcomes with different intraperitoneal dosages of imipenem/cilastatin sodium.
Main Methods:
- A prospective study treated 50 episodes of CAPD peritonitis with imipenem/cilastatin sodium.
- Patients received an intravenous loading dose followed by 10 days of intraperitoneal administration.
- Two dosage regimens were compared: 20 mg (1989) and 100 mg (1990) per 2-liter PD fluid bag.
Main Results:
- The primary response rate (polymorphonuclear neutrophils < 100/ml) was 90% in 1989 and 95% in 1990.
- Complete cure rates without relapse were 73% (1989) and 85% (1990).
- Higher intraperitoneal dosage of imipenem/cilastatin sodium correlated with improved cure rates.
Conclusions:
- Imipenem/cilastatin sodium is an effective single first-line antibiotic for CAPD peritonitis.
- Increased intraperitoneal dosage enhances treatment efficacy and reduces relapse rates.
- This antibiotic represents a viable therapeutic option for managing CAPD-associated peritonitis.
Abstract:
Imipenem/cilastatin sodium is a new thienamycin class of antibiotic with a broad spectrum of bactericidal activities. It may be a suitable single first-line therapy for the treatment of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. Fifty episodes of CAPD peritonitis were treated with imipenem/cilastatin sodium. On presentation, all patients were given an intravenous loading dose of 1 g of imipenem/cilastatin sodium followed by intraperitoneal imipenem/cilastatin sodium for 10 days. During 1989 (30 episodes), 20 mg imipenem/cilastatin sodium was added to each 2-liter bag of peritoneal dialysis (PD) fluid for 10 days. The primary response rate as defined by polymorphonuclear neutrophils < 100/ml in PD fluid was 90%. Unfortunately, 17% of the peritonitis relapsed within 14 days of stopping antibiotic. The complete cure rate without relapse was therefore 73%. During 1990 (20 episodes), 100 mg imipenem/cilastatin sodium was added to each 2-liter bag of PD fluid for 10 days. The primary response rate was 95%, the complete cure rate without relapse was 85%. Imipenem/cilastatin sodium is an effective single first-line antibiotic for the treatment of peritonitis in CAPD.