Pharmacokinetics of Clindamycin in the Plasma and Dialysate after Intraperitoneal Administration of Clindamycin Phosphoester to Patients on Continuous Ambulatory Peritoneal Dialysis: An Open-Label, Prospective, Single-Dose, Two-Institution Study

We evaluated the pharmacokinetics of clindamycin and the dose of clindamycin phosphate necessary to treat peritonitis after intraperitoneal administration of clindamycin phosphate to patients on continuous ambulatory peritoneal dialysis (CAPD). This was an open-label, prospective, single-dose study conducted at the two levels of institutional clinical care in South Korea. Twelve patients (six men and six women; all older than 25years), mean CAPD duration of 38.2months with various origins without peritonitis, received 600mg clindamycin phosphate mixed with only the first 2-L dialysate (1.5% dextrose). The 1.5%, 1.5%, 2.5% and 1.5% dextrose dialysates were serially exchanged every 6hr. If patients were non-anuric, 24-hr urine samples were also collected. Clindamycin phosphate was incompletely activated to clindamycin in the dialysate. The clindamycin concentration in the dialysate was greater than the effective concentration (5μg/mL) at 6.87μg/mL up to 6hr. So, 600mg clindamycin phosphate per every 6hr dialysate is effective for treatment of peritonitis. It has been reported that the clindamycin concentrations in the dialysate may be higher in CAPD patients with peritonitis. Thus, we can expect that intraperitoneal administration of <600mg clindamycin phosphate per every 6hr dialysate could be maintained over 5μg/mL in patients with peritonitis. The transfer of clindamycin was unidirectional from the dialysate to the plasma.