PKP-001 Vancomycin intraperitoneal in paediatric patients: need to monitor plasma levels

Abstract

BackgroundPeritonitis is a frequent complication in peritoneal dialysis. Intraperitoneal administration of antibiotics appears to improve the response to intravenous treatment.PurposeTo describe a case of intraperitoneal administration of vancomycin in a paediatric patient and evolution of plasma levels.Material and methodsProspective case tracking and collaboration in the identification and interpretation of plasma levels of vancomycin.ResultsThe case was a 3-month-old girl (4.2 kg) that after cardiac surgery presented with acute tubular necrosis and needed continuous venovenous haemodiafiltration (CVVHDF). After 16 days of CVVHDF, this was changed to peritoneal dialysis. 6 days after initiation of peritoneal dialysis, peritonitis developed, and ceftazidime and vancomycin intraperitoneally were prescribed. Vancomycin was prescribed at a dose of 15 mg/L of dialysate (37.5 mg in each bag of 2.5 L). The first determination of plasma levels of vancomycin (at 24 hours) was 14.63 µg/mL and it was recommended to continue with the same dose. Treatment with intraperitoneal vancomycin continued for 21 days. During that time 11 determinations of plasma levels of vancomycin were made (range 8.19–32.93 µg/mL). A level of 32.93 µg/mL on day 10 of treatment indicated an error in the preparation of the dialysis fluid (presentation of dialysate was modified from 2.5 L to 2 L and the same vancomycin amount was added). Intraperitoneal administration of vancomycin (15 mg/L of dialysis fluid) was effective (negativisation crop) and safe (serum creatinine levels maintained).ConclusionIntraperitoneal administration of vancomycin is an effective alternative in methicillin resistant microorganism infections in patients undergoing peritoneal dialysis. In paediatric patients, the percentage of absorbed vancomycin is unknown. Monitoring plasma levels allows safe dosage and avoids nephrotoxicity associated with high plasma concentrations of vancomycin.References and/or acknowledgementsPaediatric and Neonatal Dosage Handbook. 22 Edition. American Pharmacists Association.No conflict of interest

Intraperitoneal vancomycin in neonates during peritoneal dialysis: A case report

“…A 3‐month‐old girl (4.2 kg) who received vancomycin 15 mg/L of dialysis fluid had a 14.63 µg/mL vancomycin serum level at 24 hours. The dose was continued for 21 days, the infection was resolved, and serum creatinine levels were maintained . In a controlled and prospective study of IP antibiotic treatment of peritonitis in children, 40 cases were treated with continuous IP vancomycin with a loading dose of 15 mg/kg followed by 30 mg/L for maintenance and therapeutic levels were reached .…”

“…The dose was continued for 21 days, the infection was resolved, and serum creatinine levels were maintained. 12 In a controlled and prospective study of IP antibiotic treatment of peritonitis in children, 40 cases were treated with continuous IP vancomycin with a loading dose of 15 mg/kg followed by 30 mg/L for maintenance and therapeutic levels were reached. 13 The latest edition of ISPD guidelines/recommendations for adult patients recommended for continuous PD a loading dose of 30 mg/kg and 1.5 mg/kg/bag for maintenance.…”