Treatment of gram-positive peritonitis with two intraperitoneal doses of vancomycin in continuous ambulatory
Abstract:
Eight patients with end-stage renal failure on continuous ambulatory peritoneal dialysis (CAPD), who developed peritonitis, received an intraperitoneal dose of vancomycin (30 mg/kg body weight) with 6 h of peritoneal dwell and then resumed their routine CAPD schedule. Vancomycin concentration in serum, peritoneal dialysate (PD) from an overnight dwell and 1, 2 and 3 h after a new exchange was measured at 48 h (in 5 patients) and 7 days (in 6 patients). Except for an occasional 1-hour peritoneal fluid sample on the 7th day, all samples had satisfactory vancomycin levels. Five of the 8 patients who had gram-positive peritonitis and 1 with 'sterile' peritonitis received another similar intraperitoneal dose of vancomycin at the 7th day. All of these patients had good therapeutic response with a negative PD culture 3 weeks after the cessation of therapy and no relapse of infection in at least 1 month of follow-up. We conclude that 2 intraperitoneal doses of vancomycin (30 mg/kg body weight) given 1 week apart with 6 h of intraperitoneal dwell is an effective and adequate treatment for gram-positive and 'sterile' peritonitis in CAPD patients.
Insights
Two intraperitoneal vancomycin doses, administered one week apart, effectively treat peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. This regimen ensures adequate vancomycin levels for successful infection clearance and prevents relapse.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Peritonitis is a significant complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Effective antibiotic treatment is crucial for managing peritonitis in CAPD patients to prevent complications and ensure treatment success.
Purpose of the Study:
- To evaluate the efficacy and adequacy of a specific intraperitoneal vancomycin dosing regimen for treating peritonitis in CAPD patients.
- To assess vancomycin concentrations in serum and peritoneal dialysate following intraperitoneal administration.
Main Methods:
- Eight CAPD patients with peritonitis received an initial intraperitoneal vancomycin dose (30 mg/kg) with a 6-hour dwell time.
- Vancomycin levels were measured in serum and peritoneal dialysate at various time points.
- A second vancomycin dose was administered on day 7 for patients with persistent or recurrent infections.
Main Results:
- Satisfactory vancomycin levels were achieved in serum and peritoneal dialysate in most samples.
- Six of the eight patients (5 with gram-positive peritonitis, 1 with 'sterile' peritonitis) received a second dose.
- All treated patients showed a good therapeutic response, with negative peritoneal dialysate cultures and no relapse within a month.
Conclusions:
- Two intraperitoneal vancomycin doses, 30 mg/kg each, given one week apart with a 6-hour dwell, represent an effective treatment for gram-positive and 'sterile' peritonitis in CAPD patients.
- This regimen provides adequate vancomycin levels for successful treatment and prevention of infection recurrence.
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