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Vancomycin kinetics during continuous ambulatory peritoneal dialysis.

C M Bunke, G R Aronoff, M E Brier

    Clinical Pharmacology and Therapeutics
    |November 1, 1983
    PubMed
    Summary

    This study determined vancomycin (VAN) dosing for continuous ambulatory peritoneal dialysis (CAPD) patients. Intraperitoneal VAN dosing requires specific loading and maintenance doses to achieve therapeutic plasma concentrations for infections.

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    Area of Science:

    • Pharmacokinetics
    • Nephrology
    • Infectious Diseases

    Background:

    • Continuous ambulatory peritoneal dialysis (CAPD) patients require specific dosing guidelines for antibiotics like vancomycin.
    • Understanding vancomycin's pharmacokinetic profile in CAPD is crucial for effective treatment and preventing resistance.

    Purpose of the Study:

    • To establish therapeutic guidelines for vancomycin usage in CAPD patients.
    • To evaluate vancomycin pharmacokinetics after intravenous (VAN-IV) and intraperitoneal (VAN-IP) administration in CAPD patients.

    Main Methods:

    • Single-dose pharmacokinetic study of vancomycin (10 mg/kg) via IV and IP routes in CAPD patients.
    • Kinetic principle of superposition used to predict plasma concentrations after repeated VAN-IP doses.
    • Modeling of once-daily dosing and vancomycin per exchange dosing regimens.

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    Main Results:

    • VAN-IV achieved plasma concentrations >10 mg/l at 12 hr (t 1/2 = 81 hr).
    • VAN-IP showed 65% absorption, peak concentrations of 6.3 mg/l, and t 1/2 of 66 hr.
    • CAPD accounted for 15-17% of total body clearance for both administration routes.

    Conclusions:

    • Proposed dosing models for VAN-IP: once-daily (30 mg/kg loading, 7 mg/kg maintenance) or per exchange (30 mg/kg loading, 1.5 mg/kg maintenance) to achieve therapeutic levels.
    • Data supports vancomycin treatment guidelines for CAPD patients with gram-positive bacterial infections and peritonitis.