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Lewis SJ, Alves B, Ratnam S, Churchwell MD. Stability and compatibility of intraperitoneal antimicrobials in peritoneal dialysate solutions. Perit Dial Int 2023; 43:431-441. [PMID: 37728078 DOI: 10.1177/08968608231196034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
To optimise antimicrobial administration in patients with peritoneal dialysis (PD)-related peritonitis, healthcare providers need literature-based information to develop patient-centred pharmacotherapeutic plans. Traditional PD solutions promote osmosis using dextrose or icodextrin with a lactate buffer. Newer PD solutions have modified the osmotic vehicle and buffer. Knowledge of antimicrobial compatibility and stability with newer PD solutions will assist with determining the route of antimicrobial administration as compatible and stable solutions could be delivered directly to the peritoneum using intraperitoneal administration. This review updates the compatibility and stability of antimicrobial additives in newer PD solutions for PD-related peritonitis.
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Affiliation(s)
- Susan J Lewis
- Department of Pharmacy Practice, University of Findlay College of Pharmacy, OH, USA
- Department of Pharmacy, Mercy Health St Anne Hospital, Toledo, OH, USA
| | | | - Shobha Ratnam
- Department of Medicine, University of Toledo College of Medicine, OH, USA
| | - Mariann D Churchwell
- Department of Pharmacy Practice, University of Toledo College of Pharmacy and Pharmaceutical Sciences, OH, USA
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Ling CW, Sud K, Patel R, Peterson G, Wanandy T, Yeoh SF, Van C, Castelino R. Culture-directed antibiotics in peritoneal dialysis solutions: a systematic review focused on stability and compatibility. J Nephrol 2023; 36:1841-1859. [PMID: 37548827 PMCID: PMC10543841 DOI: 10.1007/s40620-023-01716-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND This systematic review summarises the stability of less commonly prescribed antibiotics in different peritoneal dialysis solutions that could be used for culture-directed therapy of peritonitis, which would be especially useful in regions with a high prevalence of multidrug antibiotic-resistant strains. METHODS A literature search of Medline, Scopus, Embase and Google Scholar for articles published from inception to 25 January, 2023 was conducted. Only antibiotic stability studies conducted in vitro and not recently reviewed by So et al. were included. The main outcomes were chemical, physical, antimicrobial and microbial stability. This protocol was registered in PROSPERO (registration number CRD42023393366). RESULTS We screened 1254 abstracts, and 28 articles were included in the study. In addition to those discussed in a recent systematic review (So et al., Clin Kidney J 15(6):1071-1078, 2022), we identified 18 antimicrobial agents. Of these, 9 have intraperitoneal dosing recommendations in the recent International Society for Peritoneal Dialysis (ISPD) peritonitis guidelines, and 7 of the 9 had stability data applicable to clinical practice. They were cefotaxime, ceftriaxone, daptomycin, ofloxacin, and teicoplanin in glucose-based solutions, tobramycin in Extraneal solution only and fosfomycin in Extraneal, Nutrineal, Physioneal 1.36% and 2.27% glucose solutions. CONCLUSIONS Physicochemical stability has not been demonstrated for all antibiotics with intraperitoneal dosing recommendations in the ISPD peritonitis guidelines. Further studies are required to determine the stability of antibiotics, especially in icodextrin-based and low-glucose degradation products, pH-neutral solutions.
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Affiliation(s)
- Chau Wei Ling
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Kamal Sud
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
- Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Sydney, NSW, Australia
- Peritoneal Dialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Sydney, NSW, Australia
| | - Rahul Patel
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - Gregory Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - Troy Wanandy
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
- Department of Pharmacy, Royal Hobart Hospital, Hobart, TAS, Australia
- Department of Clinical Immunology and Allergy, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Siang Fei Yeoh
- Department of Pharmacy, National University Hospital, Singapore, Singapore
| | - Connie Van
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Ronald Castelino
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
- Department of Pharmacy, Blacktown Hospital, Blacktown, NSW, Australia
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Compatibility of aztreonam in four commercial peritoneal dialysis fluids. Sci Rep 2020; 10:1788. [PMID: 32019947 PMCID: PMC7000415 DOI: 10.1038/s41598-020-58391-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/09/2020] [Indexed: 11/08/2022] Open
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.
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