High pyridine generation in ceftazidime-icodextrin admixtures used to treat peritoneal dialysis-associated peritonitis

<p><strong>Purpose: </strong>To investigate the amount of pyridine generated from degradation of ceftazidime in icodextrin peritoneal dialysis (PD) solutions.</p> <p><strong>Methods: </strong>PD solutions that contained 1 and 1.5 g of ceftazidime were stored at 25 °C for 12 hours and then at 37 °C for 14 hours. An aliquot was withdrawn at predefined time points and analyzed for the concentrations of ceftazidime and pyridine.</p> <p><strong>Findings: </strong>The amount of pyridine generated was >225% and 400% of its maximum recommended daily exposure in the 1- and 1.5-g ceftazidime-PD admixtures, respectively.</p> <p><strong>Implications: </strong>Until these results are confirmed with appropriate <i>in vivo</i> studies, intermittent intraperitoneal dosing of ceftazidime admixed with icodextrin should be used with caution and appropriate clinical monitoring or a suitable alternative antibiotic should be used.</p>