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La vancomicina administrada por vía intraperitoneal tiene resultados en niveles de fármaco en suero y efluentes
Ezhilnilavan Sampath1, Kapil Navin Sejpal2, Apurba S Sastry3
1Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), JIPMER Campus, Puducherry, India.
Indian journal of nephrology
|September 2, 2025
Resumen
La vancomicina intraperitoneal a dosis de 15 mg/ kg cada 96 horas es insuficiente para el tratamiento de la peritonitis por diálisis peritoneal. La mayoría de los pacientes no alcanzaron los niveles séricos terapéuticos de vancomicina, lo que requirió ajustes de dosis y estudios farmacocinéticos adicionales.
Área de la Ciencia:
- Nefrología
- Farmacocinética
- Enfermedades infecciosas
Sus antecedentes:
- La vancomicina intraperitoneal es un tratamiento estándar para la peritonitis relacionada con la diálisis peritoneal (DP).
- La optimización de la dosis de vancomicina en pacientes con enfermedad renal crónica (ERC) es crucial.
- Este estudio investigó los niveles séricos de vancomicina en pacientes con EP con peritonitis utilizando un régimen de dosificación común.
Objetivo del estudio:
- Evaluar si la dosis estándar de vancomicina intraperitoneal alcanza niveles séricos terapéuticos en pacientes con EP con peritonitis.
- Evaluar la adecuación de la dosificación de vancomicina en pacientes con enfermedad renal terminal (ESRD) sometidos a PD.
Principales métodos:
- Un análisis farmacocinético de 41 episodios de peritonitis relacionados con la EP.
- Los pacientes recibieron 15 mg/ kg de vancomicina por vía intraperitoneal cada 96 horas.
- Las concentraciones de vancomicina en suero y en diálisis se midieron mediante cromatografía líquida- espectrometría de masas en tándem.
Principales resultados:
- Sólo dos de los 41 episodios alcanzaron el nivel mínimo recomendado de vancomicina en suero (> 15 mg/ l).
- El régimen de dosificación estándar no alcanzó los niveles terapéuticos de vancomicina en la mayoría de los casos de peritonitis de PD.
- Veintiún episodios requirieron la extracción del catéter de PD, lo que indica problemas de tratamiento.
Conclusiones:
- La vancomicina intraperitoneal intermitente (15 mg/ kg Q96H) es inadecuada para alcanzar niveles terapéuticos en la peritonitis relacionada con la EP.
- Hay una necesidad crítica de estudios farmacocinéticos para guiar la dosificación de antibióticos en pacientes con EP.
- Las estrategias de dosificación actuales pueden requerir revisión para mejorar la eficacia y los resultados del tratamiento.
Palabras clave:
Cromatografía líquida Espectroscopia de masasConcentración mínima inhibidoraDiálisis peritonealLa péritonitisFarmacocinéticaFunción renal residualVancomicina y sus derivadosMás Videos Relacionados
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