Pharmacokinetics of intraperitoneal cefotaxime treatment of peritonitis in patients on continuous ambulatory peritoneal dialysis.

The pharmacokinetics of intraperitoneal cefotaxime as the sole therapy in patients on continuous ambulatory peritoneal dialysis with peritonitis have been examined. The mean plasma concentrations achieved following 1 h of peritoneal instillation of 500 mg of cefotaxime were 5.0 +/- 1.6 micrograms ml-1. The average plasma concentration over 24 h was 6.9 +/- 0.4 micrograms ml-1 and was no different from that found following a further 9-11 days of successful treatment of the peritonitis. However, the mean dialysate effluent concentration of cefotaxime was increased following the resolution of the peritonitis, 165 +/- 22.7 mg per cycle on day 10 or 12 compared with 50.4 +/- 7.3 mg per cycle on day 1, suggesting enhanced peritoneal cefotaxime absorption during acute peritonitis. Nevertheless, during both periods, adequate concentrations of cefotaxime were achieved in dialysate to treat local complications, but plasma levels may be inadequate to treat systemic complications due to Staphylococcus albus.