Compatibility of aztreonam in four commercial peritoneal dialysis fluids

Selma Tobudic,Markus Obermüller,Gottfried Reznicek,Manuel Kussmann,Markus Zeitlinger,Martin Wiesholzer,Wolfgang Poeppl,Isabella Prager,Heinz Burgmann,Martin Ursli

doi:10.1038/s41598-020-58391-y

Selma Tobudic, Markus Obermüller + Show 8 more

Open Access

https://doi.org/10.1038/s41598-020-58391-y

Copy DOI

Abstract

The preferable route for treatment of peritoneal dialysis related peritonitis remains the intraperitoneal administration of antibiotics admixed to peritoneal dialysis fluids. It is important to know whether the administered drug is compatible with the PD fluids and its container. In the present study the compatibility of aztreonam with four commercial PDFs at storing temperatures and duration representative for storing conditions in the clinical settings was investigated. Aztreonam concentrations were determined using high-performance liquid chromatography. The antimicrobial activity of aztreonam was evaluated using an E. coli diffusion disk inhibition assay and P. aeruginosa time-kill curves. In Extraneal evaluated at 6 °C, 25 °C and 37 °C aztreonam was stable over the whole study period of 14 days and 24 hours, respectively. In Physioneal and Nutrineal aztreonam was stable at 6 °C for up to 14 days. Antimicrobial activity was retained in all PD fluids over the whole study period. Aztreonam remained stable and was compatible with the PD fluids, particularly with Extraneal or Nutrineal, and no compensatory dose adjustment is needed when stored for up to 14 days at refrigeration temperature before use.

Highlights

Aztreonam is a synthetic monobactam which has satisfactory stability for at least 24 h at 37 °C18. It is a safe and efficient drug for the therapy of peritonitis caused by Gram-negative bacteria in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) based on species identification and MIC values[19]
For intraperitoneal drug administration it is imperative that the drug being applied is compatible with the peritoneal dialysis fluids (PDFs) used for storage and/or administration
Stability of aztreonam in PDFs containing 7.5% icodextrin, 1.36% and 2.27% glucose, and 1.1% amino acids was studied at refrigeration-temperature (6 °C), room-temperature 25 °C and body-temperature (37 °C)

Summary

Introduction

There are no data concerning the stability and microbial activity of aztreonam in different PDFs. the present study set out to investigate the compatibility and microbial activity of aztreonam in glucose-, icodextrin-, and amino acid-containing commercial PDFs. Material and Methods Sample preparation. PDF samples of 1 ml were taken in duplicate at specific time points: 0 (directly after addition of aztreonam), 1, 2, 3, 7, 14 days for storage at refrigeration (6 °C) and room temperature (25 °C) and 0, 1, 4, 12, 24 hours for storage at body temperature (37 °C)[12,13,14].

Results

Conclusion