Abstract
Intraperitoneal administration of antibiotics together with peritoneal dialysis fluids (PDFs) remains the preferable route for treatment of peritoneal dialysis-related peritonitis. For home based therapy, antibiotic-containing PDFs are stored for up to two weeks and warmed up to body-temperature before administration. The present study investigated the compatibility of ciprofloxacin with five commercial PDFs at refrigeration-temperature, room-temperature and body-temperature. Ciprofloxacin concentrations were determined using high-performance liquid chromatography. Drug-diluent stability was evaluated by measurement of pH-values and visual inspection at each sampling point. The antimicrobial activity of ciprofloxacin was assessed by an E. coli disk diffusion method. Ciprofloxacin was stable at refrigeration-temperature and body-temperature in all PDFs evaluated over the whole study period of 14 days and 24 hours, respectively. At room-temperature, in contrast, ciprofloxacin demonstrated only limited stability in particular when tested in mixed Physioneal. Except for Physioneal 1.36%, no relevant drug adsorption was observed and the antimicrobial activity of ciprofloxacin was found to be preserved in each PDF at each storage condition investigated. Intraperitoneal ciprofloxacin might be used for inpatient and home based therapy of peritoneal dialysis-related peritonitis and no compensatory dose adjustment is needed when stored for up to two weeks at refrigeration-temperature before use.
Highlights
Bacterial peritonitis remains the main infectious complication among patients undergoing peritoneal dialysis (PD)[1,2]
With regard to the International Society of Peritoneal Dialysis (ISPD) recommendations the intraperitoneal (IP) route should be preferred for antimicrobial treatment of peritoneal dialysis related peritonitis (PDRP) due to considerably higher drug concentrations achieved at the target site[1,10]
Defined as the time from preparation until the original concentration is reduced to ≤ 90%, ciprofloxacin was stable in all peritoneal dialysis fluids (PDFs) over the whole study period of 14 days at refrigeration-temperature (6 °C) and 24 hours at body-temperature (37 °C)
Summary
Bacterial peritonitis remains the main infectious complication among patients undergoing peritoneal dialysis (PD)[1,2]. The pathogens isolated from patients with peritoneal dialysis related peritonitis (PDRP) comprise gram positive and gram negative bacteria wherefore empiric antimicrobial regimens should cover both, in consideration of local susceptibility data[1,3,4,5]. With regard to the International Society of Peritoneal Dialysis (ISPD) recommendations the intraperitoneal (IP) route should be preferred for antimicrobial treatment of PDRP due to considerably higher drug concentrations achieved at the target site[1,10]. For home based therapy of PDRP, patients are routinely supplied with antibiotic containing peritoneal dialysis fluids (PDFs) which are stored for up to two weeks and warmed up to body-temperature directly before administration. The present study investigated the compatibility of ciprofloxacin with five different commercial PDFs namely Extraneal, Nutrineal, Physioneal 1.36%, Physioneal 2.27% and Physioneal 3.86%, at various storage conditions
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