Abstract
To determine the adequate treatment for peritonitis complicating CAPD, we examined serum levels and clinical effects of the intraperitoneal administration of antibiotics, either latamoxef (LMOX) or cefoperazone (CPZ).
We added the antibiotics, 2.5g/2-liter of dialysis solution, to all exchanges. With the first administration, the sarum concentration of the antibiotics increased to adequate levels (mean of 10.4μg/ml for LMOX and 7.5μg/ml for CPZ) to prevent bacteremia.
During subsequent administrations, we maintained a high serum level of LMOX, 43-46μg/ml, and a lower level of CPZ, 8-16μg/ml, with the exception of two cases of liver dysfunction receiving CPZ, in whom the range was 25-47μg/ml, After cessation of the drugs, the serum concentration of CPZ decreased more quickly than that of LMOX.
These results suggest that CPZ is mainly eliminated by the bile or metabolized by the liver, and serum LMOX levels are higher than CPZ during use in CAPD patients who can hardly eliminate drugs by urinary excretion.
Whether we used LMOX or CPZ, white blood cell counts in dialysate decreased to less than 10/mm3 in five or six days. The LMOX treatment group seemed to respond more quickly than the CPZ group, but the difference achieved no statistical significance.
In the treatment of CAPD peritonitis, careful selection of antibiotics and adjustment of dosage should be undertaken in due consideration of their elimination site, the liver or kidney.
