Pharmacokinetics of intermittent intraperitoneal ceftazidime

• Published in: American journal of kidney diseases Vol. 33; no. 1; pp. 111 - 117
• Main Authors: Grabe, Darren W., Bailie, George R., Eisele, George, Frye, Reginald F.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Orlando, FL Elsevier Inc 01-01-1999; Elsevier
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Ceftazidime; Ceftazidime - administration & dosage; Ceftazidime - analysis; Ceftazidime - pharmacokinetics; Cephalosporins - administration & dosage; Cephalosporins - analysis; Cephalosporins - pharmacokinetics; Chromatography, High Pressure Liquid - methods; Clinical Protocols; dosing; Emergency and intensive care: renal failure. Dialysis management; Female; Half-Life; Humans; Injections, Intraperitoneal; Intensive care medicine; intraperitoneal; Male; Medical sciences; Middle Aged; peritoneal dialysis; Peritoneal Dialysis, Continuous Ambulatory - methods; Peritonitis - metabolism; Peritonitis - therapy; pharmacokinetics; Prospective Studies; Time Factors; pharmacokinetics; peritoneal dialysis; intraperitoneal; dosing; Ceftazidime; Kidney disease; Human; Urinary system disease; Treatment efficiency; β-Lactams; Case control study; Peritoneal dialysis; Intraperitoneal; Prevention; Extrarenal dialysis; Cephalosporin derivatives; Intermittent; Abdominal disease; Renal failure; Pharmacokinetics; Peritonitis; Half life
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1016/S0272-6386(99)70265-9

Ceftazidime is currently recommended as an alternative first-line agent in the treatment of peritonitis and for Pseudomonas peritonitis. The pharmacokinetics of intermittent intraperitoneal (IP) ceftazidime have been poorly characterized. This study was designed to characterize the pharmacokinetic disposition of a single dose of ceftazidime in anuric and non-anuric CAPD patients, over 48 hours. This was a prospective, open label, pharmacokinetic study. The study was conducted in an independent, outpatient dialysis center. Ten volunteer continuous ambulatory peritoneal dialysis (CAPD) patients with and without residual renal function, no peritonitis or antibiotics in the previous 4 weeks, and on CAPD for at least 2 months were recruited. Patients received a single dose of IP ceftazidime (15 mg/kg) in the first daytime exchange over a 6-hour dwell, after an overnight dwell. Serum, urine, and dialysate were collected over a 48-hour period. A high-pressure liquid chromatography (HPLC) assay was used to analyze ceftazidime in these samples. Pharmacokinetic parameters were calculated. Six of the 10 patients were non-anuric with a mean residual renal creatinine clearance of 2.9 ± 1.6 mL/min. The mean ± SD bioavailability was 72% ± 14%, and the volume of distribution was 0.34 ± 0.08 L/kg. The mean serum elimination half-life of 22 ± 5 hours. The peritoneal clearance was 5.74 ± 1.6 mL/min. No difference was detected between anuric and nonanuric patients. Mean plasma and dialysate concentrations at 24 hours were 24 ± 6 μg/mL and 18 ± 7 μg/mL, respectively, and were 12.0 ± 3.6 μg/mL and 7.4 ± 3.1 μg/mL at 48 hours, respectively. Once-daily IP dosing of ceftazidime achieves serum and dialysate levels greater than the MIC of sensitive organisms over 48 hours.