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Rapid and Effective Treatment of Peritonitis in Peritoneal Dialysis Patients with Intravenous Dalbavancin
Julia I Tegethoff1, Isaac Teitelbaum2, Tyree H Kiser1
1Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
Abstract:
BACKGROUND Peritonitis is a complication associated with peritoneal dialysis (PD), which carries a significant morbidity and mortality risk. Empiric therapy must include coverage of gram-positive organisms; vancomycin is a recommended treatment option, particularly when MRSA infection is a risk. Vancomycin is cumbersome for patients, requiring therapeutic drug monitoring and re-administration by a healthcare provider. Dalbavancin, administered as a one-time intravenous dose, is a convenient potential treatment option for PD patients to cover gram-positive organisms without the need for routine drug monitoring. CASE REPORT We present 2 patients effectively treated with dalbavancin for infectious peritonitis. The first patient, a 73-year-old woman with end-stage renal disease (ESRD) on PD, presented to the hospital with fever, elevated white blood cells (WBCs), and cloudy peritoneal fluid with elevated nucleated cell counts (88% neutrophils). This patient was given 1 dose of 1500 mg IV dalbavancin. Within 3 days, her fever resolved, WBCs returned to normal, and peritoneal fluid results improved. The second patient was a 36-year-old woman presenting to an outpatient clinic with abdominal pain and cloudy peritoneal fluid with elevated nucleated cell counts (53% neutrophils) treated with dalbavancin 1500 mg IV once. Within 4 days, this patient's pain had resolved, and peritoneal fluid results returned to baseline. No adverse effects were noted for either patient. CONCLUSIONS These cases illustrate the potential of dalbavancin as a convenient option for patients with PD-associated peritonitis. Both patients demonstrated rapid and complete response to a single dose of dalbavancin without complications. Further prospective studies are needed to establish dalbavancin as an option for peritonitis.
Insights
Dalbavancin offers a convenient, single-dose treatment for peritonitis in peritoneal dialysis (PD) patients, effectively clearing gram-positive infections without requiring drug monitoring. This approach shows promise for improving patient outcomes and simplifying treatment regimens.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Peritonitis is a serious complication of peritoneal dialysis (PD), associated with significant morbidity and mortality.
- Current empiric therapy for peritonitis requires gram-positive coverage, often with vancomycin, which necessitates drug monitoring and healthcare provider administration.
- Dalbavancin presents a potential alternative, offering a single intravenous dose for gram-positive coverage without routine therapeutic drug monitoring.
Observation:
- Two case reports detail the successful treatment of infectious peritonitis in PD patients using a single 1500 mg IV dose of dalbavancin.
- The first patient, a 73-year-old woman with end-stage renal disease (ESRD) on PD, experienced rapid resolution of fever, normalization of white blood cell counts, and improved peritoneal fluid parameters within 3 days.
- The second patient, a 36-year-old woman, reported resolution of abdominal pain and return of peritoneal fluid to baseline within 4 days of treatment.
Findings:
- Both patients demonstrated a rapid and complete clinical response to a single dose of dalbavancin.
- No adverse effects were reported in either patient treated with dalbavancin for peritonitis.
- These cases suggest dalbavancin's efficacy and tolerability as a treatment for PD-associated peritonitis.
Implications:
- Dalbavancin may offer a more convenient and effective treatment option for gram-positive peritonitis in PD patients compared to traditional therapies.
- The single-dose administration simplifies treatment and eliminates the need for frequent drug monitoring, potentially improving patient adherence and quality of life.
- Further prospective studies are warranted to confirm these findings and establish dalbavancin as a standard treatment for PD-associated peritonitis.
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