A preliminary report on the pharmacokinetics of intravenous and intraperitoneal cefoxitin in patients undergoing peritoneal dialysis

Peritoneal dialysis is one available mode of therapy in patients with renal failure. The technique of peritoneal dialysis has advantages over alternative modes of therapy, such as hemodialysis, in that it is less expensive and can be performed by the patients themselves. at home after a brief training period. A major problem complicating the use of peritoneal dialysis is the frequent occurrence of perionitis caused by a nuumber of gram-positive and gram-negative bacteria. Cefoxitin is a semi-synthetic, broad-spectrum antibiotic with demonstrated in vitro activity against a wide range of gram-positive and gram-negative organisms. The manufacturer states that organisms are considered susceptible to cefoxitin when the minimum inhibitory concentration is 16 mcg/ml or less. Cefoxitin, a cephamycin C analogue produced by Streptmyces lactamdurans, is almost entirely excreted unchanged in the urine. As cefoxitin is active against many of the organisms involved in bacterial peritonitis, it is important to determine the disposition and kinetic parameters of cefoxitin in peritoneal dialysis to aid in establishing appropriate therapeutic regimens for patients undergoing peritoneal dialysis and who develop a bacterial pertonitis. This study was designed to, therfore, to evaluate: 1. The pharamcokinetics of cefoxitin in patients during peritoneal dialysis; 2. The total amount of drug removed by peritoneal dialysis; 3. The ration of serum to dialysate (pertonieal fluid) concentrations of cefoxitin following intravenous and intraperitoneal administration of cefoxitin; 4. The serum concentrations of cefoxitin attained in patients, in the presence and absence of peritonitis, and a comparison with minimum inhibitory concentrations cited for common etiologic organisms; 5. The dialsylate concentrations of cefoxitin that are attained and maintained during the course of cefoxitin therapy in patients, in the presence and absence of peritonitis, and a comparison cited for common etiologic organisms; 6. The methodology used to determine it use as a model for further study of other antibiotics used in patients requiring peritoneal dialysis.