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Intraperitoneal Vancoled does not cause chemical peritonitis
C A Johnson1, S W Zimmerman, S Engeseth
1Department of Medicine, University of Wisconsin Hospital, Madison.
Abstract:
A prior report has suggested that loading doses of intraperitoneal Vancoled (vancomycin, Lederle) cause chemical peritonitis in patients with catheter infections. The present open-label study was conducted to determine the effects of a 30 mg/kg intraperitoneal loading dose of Vancoled given to five patients with a culture-positive, erythematous, draining exit-site infection. Prior to dosing, all dialysate was drained and sent for baseline cell count and culture. The loading dose was added to the dialysate and infused in the usual fashion. A sample of dialysate was drained at two hours and sent for cell count and culture. The entire exchange was drained at four hours and also sent for cell count and culture. Serum vancomycin concentrations wer measured at four hours. Baseline dialysate contained less than 9 white blood cells per microliter in all patients. Two and four hour samples contained less than 4 and less than 11 white blood cells per microliter, respectively. All fluid was sterile. WB C differential counts were unremarkable. No adverse effects occurred. The mean serum vancomycin concentration was 26.5 micrograms/ml. Intraperitoneal Vancoled did not cause chemical peritonitis and was well-tolerated by patients with exit-site infections.
Insights
Intraperitoneal vancomycin loading doses did not cause chemical peritonitis in patients with catheter exit-site infections. This study found the treatment well-tolerated, with no adverse effects observed in the participants.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Previous studies suggested intraperitoneal vancomycin loading doses may induce chemical peritonitis.
- Catheter-related infections, particularly exit-site infections, are a common complication in patients undergoing peritoneal dialysis.
Purpose of the Study:
- To evaluate the safety and potential for chemical peritonitis of a 30 mg/kg intraperitoneal vancomycin loading dose.
- To assess the impact of this vancomycin loading dose on peritoneal fluid parameters and patient tolerance in the context of exit-site infections.
Main Methods:
- Open-label study involving five patients with culture-positive, erythematous, draining exit-site infections.
- Administration of a 30 mg/kg intraperitoneal vancomycin loading dose after draining existing dialysate.
- Collection of peritoneal dialysate samples at baseline, 2 hours, and 4 hours for cell count and culture.
- Measurement of serum vancomycin concentrations at 4 hours post-administration.
Main Results:
- Baseline dialysate white blood cell counts were below 9 cells/µL.
- Post-dosing dialysate cell counts remained low (2-hour: <4 cells/µL; 4-hour: <11 cells/µL).
- All dialysate and fluid samples were sterile, with unremarkable white blood cell differential counts and no reported adverse effects.
Conclusions:
- Intraperitoneal vancomycin loading doses did not induce chemical peritonitis in patients with exit-site infections.
- The administration of vancomycin via intraperitoneal loading dose was well-tolerated in this patient cohort.
- Findings suggest current protocols for vancomycin loading doses in this context are safe.