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Published on: March 3, 2023
Intraperitoneal vancomycin concentrations during peritoneal dialysis-associated peritonitis: correlation with serum
Richard Fish1, Robert Nipah, Chris Jones
1Department of Renal Medicine and Transplantation, The Royal London Hospital, London, UK.
Summary
Achieving adequate vancomycin serum levels does not guarantee therapeutic peritoneal dialysate effluent (PDE) concentrations for peritoneal dialysis-associated peritonitis (PDP). Intermittent vancomycin dosing may lead to sub-optimal intraperitoneal antibiotic levels, necessitating further investigation into optimal dosing strategies.
Area of Science:
- Pharmacology and Therapeutics
- Nephrology
- Infectious Diseases
Background:
- Peritoneal dialysis-associated peritonitis (PDP) treatment guidelines suggest maintaining serum vancomycin concentrations between 12-15 mg/L.
- Limited data exist correlating vancomycin serum and peritoneal dialysate effluent (PDE) levels during active PDP infection.
- This study investigates the relationship between serum and PDE vancomycin concentrations to assess therapeutic efficacy.
Purpose of the Study:
- To determine if achieving recommended serum vancomycin levels results in adequate intraperitoneal concentrations during PDP treatment.
- To evaluate the consistency of vancomycin efflux from serum to PDE during a 4-hour dwell period.
Main Methods:
- A study of patients with non-gram-negative PDP treated with intraperitoneal (i.p.) vancomycin.
- Administration of a single vancomycin dose (approx. 30 mg/kg) at presentation.
- Measurement of vancomycin levels in PDE at day 5 to assess 4-hour dwell efflux.
Main Results:
- Serum vancomycin levels >12 mg/L were achieved in 98% of 48 PDP episodes.
- However, 23% of patients had PDE vancomycin levels <4 mg/L (below MIC for many pathogens) at day 5.
- A statistically significant but poor correlation (R²=0.18) was found between serum and PDE vancomycin concentrations.
Conclusions:
- While intermittent vancomycin dosing achieves adequate serum concentrations, it does not consistently ensure therapeutic PDE levels for PDP.
- PDE vancomycin concentrations may not consistently exceed the minimum inhibitory concentration (MIC) of key pathogens.
- Continuous dosing of vancomycin for PDE may be a preferable strategy for adults with PDP, similar to pediatric recommendations.
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