Abstract: FR-PO505
Dialysate and Plasma Meropenem Concentrations in Continuous Intraperitoneal Regimen During Peritoneal Dialysis-Related Peritonitis
Session Information
- Peritoneal Dialysis: Modality, Catheter, Infections
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Peritoneal Dialysis
Authors
- Srithongkul, Thatsaphan, Division of Nephrology, Internal Medicine, Siriraj Hospital, Bangkok, Thailand
- Raksasuk, Sukit, Division of Nephrology, Internal Medicine, Siriraj Hospital, Bangkok, Thailand
- Techajongnumchai, Bulaporn, Division of Nephrology, Internal Medicine, Siriraj Hospital, Bangkok, Thailand
- Sritippayawan, Suchai, Division of Nephrology, Internal Medicine, Siriraj Hospital, Bangkok, Thailand
Background
Peritonitis is a major complication in peritoneal dialysis (PD) patients. Currently, the increase of intraperitoneal (IP) meropenem used regarding the rise in resistant organisms. A single dose of IP meropenem was recommended. However, data on the continuous regimen of IP meropenem is still limited. We examined plasma and dialysate meropenem level in the continuous IP meropenem in PD related peritonitis.
Methods
A prospective, descriptive study was performed in 8 patients with PD related peritonitis. Seven patients received a loading dose of meropenem 500 mg IP followed by meropenem 125 mg/L IP (4 exchanges daily). Another patient received the recommended intermittent IP meropenem 1 g daily. Concentrations of meropenem in plasma and dialysate were measured at specified intervals over 24 h with a high-performance liquid chromatography method.
Results
In the continuous group, the mean of maximum meropenem level was 340.6 mg/L (standard deviation [SD] ± 21.5) and 28.7 mg/L (SD ± 21.5) in dialysate and plasma, respectively. At 24 hour, mean dialysate drug level was minimum at 45.3 mg/L (SD ± 36.2). Dialysate meropenem concentrations from this regimen exceeded MIC of the pathogenic resistance organism (MIC > 8 mg/L) at every time points. For the intermittent regimen, mean plasma and dialysate meropenem levels were 11.8 mg/L (SD ± 8.2) and 34.2 mg/L (SD ±35.7), respectively. Interestingly, dialysate meropenem concentration at 12 hours after 1 g of meropenem was 4.9 mg/L which may not provide adequate drug level for resistant organisms. Five patients (71%) responded to the treatment, but two patients (29%) developed treatment failure from fungal peritonitis. No major side effect was observed.
Conclusion
Meropenem loading 500 mg and continue with 125 mg/L provide adequate dialysate meropenem concentration and could be considered for effective treatment in PD related peritonitis.
Dialysate meropenem level
Funding
- Government Support - Non-U.S.