The objectives of this study were to provide a summary of the pharmacokinetic data of some intraperitoneal (IP)
antibiotics that could be used for both empirical and culture-directed
therapy, as per the ISPD recommendations, and examine factors to consider when using IP
antibiotics for the management of automated
peritoneal dialysis (APD)-associated
peritonitis. A literature search of PubMed, EMBASE, Scopus, MEDLINE and Google Scholar for articles published between 1998 and 2020 was conducted. To be eligible, articles had to describe the use of
antibiotics via the IP route in adult patients ≥18 years old on APD in the context of pharmacokinetic studies or case reports/series. Articles describing the use of IP
antibiotics that had been recently reviewed (
cefazolin,
vancomycin,
gentamicin and
ceftazidime) or administered for non-APD-associated
peritonitis were excluded. A total of 1119 articles were identified, of which 983 abstracts were screened. Seventy-three full-text articles were assessed for eligibility. Eight records were included in the final study. Three reports had pharmacokinetic data in patients on APD without
peritonitis. Each of
cefepime 15 mg/kg IP,
meropenem 0.5 g IP and
fosfomycin 4 g IP given in single doses achieved drug plasma concentrations above the minimum inhibitory concentration for treating the susceptible organisms. The remaining five records were case series or reports in patients on APD with
peritonitis. While pharmacokinetic data support intermittent
cefepime 15 mg/kg IP daily, only
meropenem 0.5 g IP and
fosfomycin 4 g IP are likely to be effective if given in APD exchanges with dwell times of 15 h. Higher doses may be required in APD with shorter dwell times. Information on therapeutic efficacy was derived from case reports/series in individual patients and without therapeutic drug monitoring. Until more pharmacokinetic data are available on these
antibiotics, it would be prudent to shift patients who develop
peritonitis on APD to
continuous ambulatory peritoneal dialysis, where pharmacokinetic information is more readily available.