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[Pharmacokinetics of vancomycin in chronic renal failure patients in continuous ambulatory peritoneal dialysis (CAPD)
Abstract:
Peritonitis is one of the most serious complication concerning patients under continuous ambulatory peritoneal dialysis (CAPD). A Staphylococcus (aureus, epidermidis) is the causative pathogen in nearly 60% of cases. This prompted a study of vancomycin, a potent antistaphylococcal agent (MIC less than or equal to 3 micrograms/ml) in 13 patients with peritonitis. Vancomycin was used as single drug therapy. Kinetics were studied after a single injection of 1 g into the dialysate bag. Serum and peritoneal concentrations exceeding 3-4 micrograms/ml were found to persist for four days; half-life was 62.3 and 54.8 h in the dialysate and serum respectively. Peritoneum to serum diffusion varied widely across individuals. In 15% of patients, serum concentration exceeded the potentially ototoxic level (80 micrograms/ml) for a few hours.
Insights
Vancomycin effectively treats Staphylococcus peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. Drug levels in serum and peritoneal fluid remained therapeutic for four days, though some patients experienced transiently high serum concentrations.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacokinetics
Background:
- Peritonitis is a severe complication in continuous ambulatory peritoneal dialysis (CAPD) patients.
- Staphylococcus species are responsible for approximately 60% of CAPD peritonitis cases.
Purpose of the Study:
- To evaluate the efficacy and pharmacokinetics of vancomycin as a single-agent therapy for Staphylococcus peritonitis in CAPD patients.
Main Methods:
- A study involving 13 CAPD patients with peritonitis treated with vancomycin.
- Kinetics were assessed after a single 1g dose administered into the dialysate bag.
- Serum and peritoneal fluid concentrations were monitored over time.
Main Results:
- Vancomycin demonstrated potent antistaphylococcal activity (MIC ≤ 3 µg/ml).
- Therapeutic concentrations (>3-4 µg/ml) persisted in serum and peritoneal fluid for four days.
- Half-life was approximately 62.3 hours in dialysate and 54.8 hours in serum.
- Peritoneum-to-serum diffusion varied significantly among patients.
- Transiently high serum concentrations (>80 µg/ml), potentially ototoxic, occurred in 15% of patients.
Conclusions:
- Vancomycin is an effective treatment for Staphylococcus peritonitis in CAPD.
- Understanding individual pharmacokinetic variability is crucial for optimizing vancomycin dosing.
- Monitoring for potential toxicity due to high serum concentrations is warranted.