The Use of Gentamicin in Peritoneal Dialysis: II. Microbiologic and Clinical Results

Hyams, Phineas J.; Smithivas, Thana; Matalon, Robert; Katz, Lois A.; Rahal, James J.

doi:10.1093/infdis/124.supplement_1.s84

Cited by 10 publications

(2 citation statements)

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“…However, from these total, 38 case series [ 15 – 52 ] were not included in the meta-analysis due to the lack of data. Methodological aspects of five RCT studies [ 53 – 57 ] had a risk of introducing bias, with inadequate blinding of participants, random sequence generation and incomplete outcome, and three RCTs was excluded from the quantitative analysis due to lack of data [ 53 , 56 , 58 ].…”

Section: Resultsmentioning

confidence: 99%

Efficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysis

et al. 2014

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BackgroundThe choice of antimicrobials for initial treatment of peritoneal dialysis (PD)-related peritonitis is crucial for a favorable outcome. There is no consensus about the best therapy; few prospective controlled studies have been published, and the only published systematic reviews did not report superiority of any class of antimicrobials. The objective of this review was to analyze the results of PD peritonitis treatment in adult patients by employing a new methodology, the proportional meta-analysis.MethodsA review of the literature was conducted. There was no language restriction. Studies were obtained from MEDLINE, EMBASE, and LILACS. The inclusion criteria were: (a) case series and RCTs with the number of reported patients in each study greater than five, (b) use of any antibiotic therapy for initial treatment (e.g., cefazolin plus gentamicin or vancomycin plus gentamicin), for Gram-positive (e.g., vancomycin or a first generation cephalosporin), or for Gram-negative rods (e.g., gentamicin, ceftazidime, and fluoroquinolone), (c) patients with PD-related peritonitis, and (d) studies specifying the rates of resolution. A proportional meta-analysis was performed on outcomes using a random-effects model, and the pooled resolution rates were calculated.ResultsA total of 64 studies (32 for initial treatment and negative culture, 28 reporting treatment for Gram-positive rods and 24 reporting treatment for Gram-negative rods) and 21 RCTs met all inclusion criteria (14 for initial treatment and negative culture, 8 reporting treatment for Gram-positive rods and 8 reporting treatment for Gram-negative rods). The pooled resolution rate of ceftazidime plus glycopeptide as initial treatment (pooled proportion = 86% [95% CI 0.82–0.89]) was significantly higher than first generation cephalosporin plus aminoglycosides (pooled proportion = 66% [95% CI 0.57–0.75]) and significantly higher than glycopeptides plus aminoglycosides (pooled proportion = 75% [95% CI 0.69–0.80]. Other comparisons of regimens used for either initial treatment, treatment for Gram-positive rods or Gram-negative rods did not show statistically significant differences.ConclusionWe showed that the association of a glycopeptide plus ceftazidime is superior to other regimens for initial treatment of PD peritonitis. This result should be carefully analyzed and does not exclude the necessity of monitoring the local microbiologic profile in each dialysis center to choice the initial therapeutic protocol.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-445) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Efficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysis

et al. 2014

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“…site o f the infection [5][6][7], For those CPD patients who utilize automated proportioning peritoneal dialysis ma chines, the antibiotic agent would have to be added to a peritoneal dialysate concentrate solution which may be prepared hours prior to and utilized throughout the 8-to 12-hour dialysis procedure.…”

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confidence: 99%

Stability of Gentamicin and Tobramycin in Concentrate Solutions for Automated Peritoneal Dialysis

Nance¹,

Matzke²

1984

Am J Nephrol

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Stability of gentamicin and tobramycin in 30 and 50% dextrose peritoneal dialysate concentrate (PDC) fluids was determined at room temperature. All solutions were prepared and stored at 23 °C and aliquots were obtained at 0, 1, 2, 4, 8, 12, 24, and 48 h. A degradation rate constant K_deg was calculated from the concentration time curve of each solution. The length of time required for the gentamicin and tobramycin concentrations to decline to 90% of the initial concentration (t₉₀) was also calculated. The K_deg of gentamicin in all solutions was less than the K_deg of tobramycin. The K_deg increased markedly for gentamicin and tobramycin as the dextrose concentration increased in the PDC. Gentamicin is stable in the 30 and 50% PDC for at least 24 h at 23 °C. Tobramycin, however, demonstrated more than a 10% loss of activity in some PDC solutions. If tobramycin is to be added to PDC, especially the 50% dextrose solution, it should be used within 12 h after admixture.

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Comments on Dialysis Solution, Antibiotic Transport, Poisonings, and Novel Uses of Peritoneal Dialysis

Rubin¹

1989

Peritoneal Dialysis

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The Use of Gentamicin in Peritoneal Dialysis: II. Microbiologic and Clinical Results

Cited by 10 publications

References 0 publications

Efficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysis

Efficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysis

Stability of Gentamicin and Tobramycin in Concentrate Solutions for Automated Peritoneal Dialysis

Comments on Dialysis Solution, Antibiotic Transport, Poisonings, and Novel Uses of Peritoneal Dialysis

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