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Toxicologic and pharmacokinetic evaluation of a case of vancomycin intoxication during continuous ambulatory
Abstract:
The use of vancomycin is rapidly increasing due to the emergence of strains of staphylococci resistant to betalactam antibiotics. In this communication the pharmacokinetics of an overdose of vancomycin in a patient during continuous ambulatory peritoneal dialysis (CAPD) is reported. Brainstem auditory evoked potentials (BAEPs) are used to assess ototoxicity. It could be shown that by shortening the dwell time, the apparent CAPD flow was increased and the vancomycin clearance was also increased. This may explain in part the differences in the values of vancomycin t1/2 in this patient (21 h) as compared to other studies (60-120 h). The age of the patient (3.5 years) may also have influenced the t1/2. Using brainstem auditory evoked potentials as a parameter to assess ototoxicity, it was shown that this patient suffered no damage from the overdose.
Insights
Vancomycin overdose in a child on continuous ambulatory peritoneal dialysis (CAPD) showed no ototoxicity. Shortening CAPD dwell time increased vancomycin clearance, potentially explaining lower half-life values.
Area of Science:
- Pharmacology
- Nephrology
- Toxicology
Background:
- Vancomycin use is increasing due to rising antibiotic resistance.
- Continuous ambulatory peritoneal dialysis (CAPD) alters drug pharmacokinetics.
- Assessing vancomycin ototoxicity is crucial, especially in pediatric patients.
Purpose of the Study:
- To report the pharmacokinetics of a vancomycin overdose in a pediatric CAPD patient.
- To evaluate ototoxicity using brainstem auditory evoked potentials (BAEPs).
- To investigate the impact of CAPD parameters on vancomycin clearance and half-life.
Main Methods:
- Case report of a vancomycin overdose in a 3.5-year-old CAPD patient.
- Pharmacokinetic analysis of vancomycin levels.
- Assessment of ototoxicity via brainstem auditory evoked potentials (BAEPs).
- Manipulation of CAPD dwell time to assess its effect on drug clearance.
Main Results:
- The patient experienced a vancomycin overdose but showed no signs of ototoxicity via BAEPs.
- Shortening CAPD dwell time increased apparent CAPD flow and vancomycin clearance.
- Vancomycin half-life (t1/2) was 21 hours, shorter than typically reported (60-120 hours).
- Patient age may have influenced the observed vancomycin half-life.
Conclusions:
- CAPD parameters, specifically dwell time, can significantly influence vancomycin clearance.
- Shortened dwell times may enhance vancomycin removal in CAPD patients.
- Vancomycin overdose in this pediatric CAPD patient did not result in ototoxicity.
- Further research is needed to optimize vancomycin dosing in CAPD patients.