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The use of gentamicin in peritoneal dialysis. I. Pharmacologic results.

Seventeen azotemic patients were treated with gentamicin during 28 instances of peritoneal dialysis. Twenty-four of 28 yielded a persistently turbid dialysate containing predominantly polymorphonuclear leukocytes. Four patients received gentamicin prophylactically or because of systemic infection. Antibiotic was given by either the intramuscular or intraperitoneal route alone in 21 cases and by a combination of both in seven. Despite the presence of peritoneal inflammation, intramuscular gentamicin alone resulted in suboptimal peritoneal and variable serum concentrations. Intraperitoneal administration produced equilibration between the two compartments after 12 hr. In the absence of peritoneal inflammation the removal rate of gentamicin from one patient was 1596-2596 of that found in three with peritonitis, and the half-life was prolonged two- to fivefold. When gentamicin was used for the treatment of peritonitis during dialysis, therapeutic levels in both serum and dialysate were most readily achieved and maintained by one or two intramuscular injections with continuous addition of antibiotic to the dialysis fluid.