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Once weekly intraperitoneal therapy for gram-positive peritonitis
G D Morse1, D K Nairn, J J Walshe
1Department of Medicine, State University of New York, Buffalo 14215.
Abstract:
The pharmacokinetics and clinical outcome following a 30 mg/kg/2 L intraperitoneal (IP) dose of vancomycin, which was administered once a week for 3 weeks, was studied in ten continuous ambulatory peritoneal dialysis patients with peritonitis. Vancomycin was 91% absorbed following the first dose and rapidly achieved therapeutic serum concentrations, 19 +/- 8 mcg/mL at 1 hour and a peak of 37 +/- 8 mcg/mL at 6 hours. Vancomycin was eliminated slowly with a mean total clearance of 7 +/- 3 mL/min/70 kg and a distribution volume of 1.2 +/- 0.3 L/kg. The resultant mean serum t1/2 over the first week was 184 hours and the mean serum concentration at 168 hours was 10 +/- 4 mcg/mL. Based on the positive clinical outcome (100% cure) among patients with uncomplicated gram-positive peritonitis, the potential use of this alternative vancomycin dosing regimen is proposed.
Insights
A weekly intraperitoneal dose of vancomycin effectively treated peritonitis in dialysis patients, achieving therapeutic levels and a 100% cure rate for gram-positive infections. This regimen offers a promising alternative for managing peritonitis in continuous ambulatory peritoneal dialysis.
Area of Science:
- Nephrology
- Pharmacology
- Infectious Diseases
Background:
- Peritonitis is a common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Effective antibiotic management is crucial for successful treatment and prevention of complications.
- Vancomycin is a key antibiotic used for peritonitis, but optimal dosing in CAPD patients requires study.
Purpose of the Study:
- To evaluate the pharmacokinetics of a novel intraperitoneal (IP) vancomycin dosing regimen in CAPD patients.
- To assess the clinical outcomes and efficacy of this vancomycin regimen in treating peritonitis.
Main Methods:
- Ten CAPD patients with peritonitis received a 30 mg/kg/2 L IP dose of vancomycin once weekly for 3 weeks.
- Serum vancomycin concentrations were monitored over time.
- Pharmacokinetic parameters (absorption, clearance, volume of distribution, half-life) were calculated.
- Clinical outcomes, including cure rates, were assessed.
Main Results:
- Vancomycin demonstrated high absorption (91%) after the first dose, rapidly achieving therapeutic serum concentrations.
- Mean peak serum concentration was 37 ± 8 mcg/mL at 6 hours.
- Slow elimination was observed, with a mean serum half-life of 184 hours.
- A mean serum concentration of 10 ± 4 mcg/mL was maintained at 168 hours.
- 100% clinical cure rate was achieved in patients with uncomplicated gram-positive peritonitis.
Conclusions:
- The studied weekly IP vancomycin dosing regimen is well-absorbed and achieves sustained therapeutic serum concentrations in CAPD patients.
- This regimen resulted in a high cure rate for gram-positive peritonitis, suggesting its potential as an effective alternative treatment.
- Further investigation into this dosing strategy is warranted for managing peritonitis in CAPD populations.