Penicillin系ならびにCephalosporin-C系抗生剤による腎機能障害時の化学療法　第2報人工透析時について

抄録

The kinetics of broad-spectirum penieillis and cephalosporins were studied in patients treated with peritoneal and haemodialysis after intravenous, oral or peritoneal load to determine the proper dose of these antibiotics in dialysis treatment. The method used in assays in serum and dialysate was the same as described in previous report.1) The half-life in serum of patients with peritoneal dialysis was almost comparable to that of patients without dialysis. The half-life in haemodialysis, however, was somewhat shorter and comparable to that of moderately impaired renal function. No difference was seen in Kolff and Kiil kidney.2) The recovery in peritoneal fluid after 9-10 hours dialysis was 30% of oral CEX dose and 10-20% of doses loaded intravenously. The recovery of AB-PC and CE was more than that in severly impaired without dialysis in 24 hours urine.3) When an antibiotic was added to dialysate in amount of 62.5 mcg/ml, its peritonal absorption rate was calculated as 30-60% and its serum concentration exceeded 10 mcg/ ml at the end of dialysis. The concentration obtained in peritoneal fluid exceeded the MIC against E. coli, Staphylococcus aureus, Staphylococcus albus and Enterococcus, was considered to be sufficient to prevent the peritoneal infection. However, the serum concentration obtained insufficient for prevention or treatment of infection: other tissues and organs.4) The recovery rate of CET in dialysate of haemodialysis with kolff kidney was 8 %, and the rate of CER and penillins 40%.5) The peritoeal clearance rate of these antibiotics was 1/3-1/4 of that of haemodialysis and the results seemed to well explain the difference of the half-life in serum in dialysis.6) It is concluded that 500 mg dose of hetacillin, AB-PC, CER, CEZ, or CEX was required at the end of haemodialysis in addition to the dose used in severely impaired patients, while no additional antibiotics, was needed in patients with peritoneal dialysis.