Single daily dosage of
netilmicin is generally accepted in systemic
infections, due to biphasic bactericidal activity and prolonged postantibiotic effect of
aminoglycosides. Since little is known about the efficacy of single daily intraperitoneal application of
netilmicin in the treatment of
CAPD-associated
peritonitis, we conducted this prospective study. Seven patients with
CAPD-associated
peritonitis were treated with a single daily dose of
netilmicin (loading dose 1.5 mg/kg, followed by 40 mg/21 bag/day). Serum and intraperitoneal levels as well as bactericidal activity of
netilmicin against Acinetobacter baumanii, E. coli and Pseudomonas aeruginosa were measured for 48 hours. Serum and peritoneal levels widely varied among the patients due to different interindividual plasma clearance of
netilmicin. The intraperitoneal antibacterial action of
netilmicin was decreased, more over, substantial differences in the bactericidal activity were found among the patients. However, with high initial
netilmicin levels sufficient bactericidal activity was found for Acinetobacter and E. coli, but not for Pseudomonas aeruginosa. Hence, a single daily dosage of
netilmicin can be a suitable treatment of
CAPD-associated
peritonitis, only if the dose is adapted according to the first serum and peritoneal levels. In
infections with Pseudomonas aeruginosa higher peritoneal levels of
netilmicin and the combination with other
antibiotics will be needed for a sufficient peritoneal bactericidal activity.