Comparative simulation of intraperitoneal aminoglycoside regimens for patients with peritonitis on automated peritoneal dialysis

Intraperitoneal aminoglycosides remain the mainstay of empiric peritonitis treatment, but optimal dosing during automated peritoneal dialysis (APD) has not been well studied. This retrospective analysis used prior peritoneal and plasma concentration data to build an in silico pharmacokinetic model, then simulated two intraperitoneal aminoglycoside dosing regimens (a loading-dose regimen versus a fixed-dose regimen) for patients on APD with peritonitis using Phoenix WinNonlin. Both regimens achieved over 90% of the target peak-to-MIC and AUC-to-MIC ratios, though the loading-dose regimen produced 2.5-fold higher peritoneal exposure on day 1, with similar plasma trough accumulation between regimens by day 5. The findings support continuing to recommend the fixed-dose regimen for peritoneal dialysis-associated peritonitis in APD patients, with plasma trough monitoring after day 3 to assess drug accumulation.