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Intravenous vancomycin as initial treatment for gram-positive peritonitis in patients on chronic peritoneal dialysis
Abstract:
Fourteen episodes of peritonitis complicating chronic peritoneal dialysis were treated with intravenous injections of 1 gm of vancomycin weekly for 4 successive weeks. Peak (one hour after completion of injection) and trough (immediately before the next injection) serum and dialysate vancomycin levels were measured. Vancomycin treatment resulted in a cure in 12 episodes (85.7%). Serum vancomycin levels were always above therapeutic range, but did not rise, with subsequent injections, to toxic range. Dialysate vancomycin levels were therapeutic for more than 85% of the measurements. One patient, who failed to respond to vancomycin plus cephalosporins, was cured with intraperitoneal streptokinase plus the same antibiotics. In another patient, a relapse was cured with vancomycin plus oral rifampin. Dialysate vancomycin levels were therapeutic in the last two patients. Peritoneal catheters were not removed. No significant side effects of vancomycin treatment were observed.
Insights
Intravenous vancomycin effectively treated peritonitis in chronic peritoneal dialysis patients, achieving an 85.7% cure rate. Serum and dialysate vancomycin levels remained within safe and therapeutic ranges throughout treatment.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Peritonitis is a serious complication of chronic peritoneal dialysis.
- Effective antibiotic treatment is crucial for managing peritonitis in these patients.
Purpose of the Study:
- To evaluate the efficacy and safety of intravenous vancomycin for treating peritonitis in chronic peritoneal dialysis patients.
- To assess serum and dialysate vancomycin levels during treatment.
Main Methods:
- Fourteen episodes of peritonitis were treated with weekly intravenous vancomycin (1 gm) for four weeks.
- Serum and dialysate vancomycin levels were measured at peak and trough intervals.
- Treatment outcomes and side effects were monitored.
Main Results:
- A cure was achieved in 12 out of 14 episodes (85.7%).
- Serum vancomycin levels were consistently therapeutic and below toxic levels.
- Dialysate vancomycin levels were therapeutic in over 85% of measurements.
- No significant side effects were observed.
Conclusions:
- Intravenous vancomycin is an effective and safe treatment for peritonitis in chronic peritoneal dialysis.
- Maintaining therapeutic vancomycin levels in both serum and dialysate is achievable with this regimen.
- Further management strategies may be needed for refractory cases or relapses.