Vancomycin therapy for serious staphylococcal infections in chronic hemodialysis patients

Vancomycin therapy during 7 episodes of serious staphylococcal infections in chronic hemodialysis patients was monitored by a sensitive bioassay technique. One gm of vancomycin was given during dialysis at a mean dosage interval of 7 days for a mean duration of 48 days. Serum peak and trough vancomycin levels were monitored during therapy. Accumulation of vancomycin occurred in 1 patient on prolonged therapy; progressive rising through levels required a reduction in vancomycin dosage. Pre and post-dialysis vancomycin levels in one patient were unchanged. Vancomycin was effective in eradication of all staphylococcal infections and bacteremias. Three A-V shunt infections required surgical revision; 2 A-V fistula infections were salvaged with vancomycin therapy alone. We conclude that 1 gm vancomycin every 7 days is an effective regimen for serious staphylococcal infections in chronic hemodialysis patients. Monitoring of vancomycin levels insures maintenance of adequate levels and prevents toxic accumulation.