Peritonitis in Automated Peritoneal Dialysis: Antibiotic Therapy and Pharmacokinetics

The use of automated peritoneal dialysis (APD) has increased markedly during the past decade, in response to the need to obtain higher clearances and to accommodate individual lifestyles. Peritonitis rates have been observed to be generally lower in APD as compared with continuous ambulatory peritoneal dialysis (CAPD). Still, peritonitis remains a significant complication of APD. Many questions have been raised regarding the appropriateness of applying, to APD, the therapeutic antibiotic regimens used for treatment of peritonitis in CAPD. The original recommendations for treatment of peritonitis in PD mostly used peritoneal dialysate trough levels based on 2-L CAPD exchanges lasting 4 ‐ 8 hours. Because APD uses shorter, more frequent exchanges, with variable fill volumes, at night, the clearance of many antibiotics is expected to be higher than in CAPD. The use of single daily doses injected intraperitoneally (IP) during the long exchange of CAPD or APD has simplified the administration of antibiotics, and arguably, allows a uniform dose to be used for both modalities. However, the higher clearance of some antibiotics during rapid cycling may reduce tissue concentrations below the therapeutic range. Recent pharmacokinetic studies have shed light on this important subject. Those studies should be used as a base from which to design more effective therapeutic guidelines. INCIDENCE OF PERITONITIS IN APD AND CAPD