Treatment of Gram-Positive Peritonitis with Two Intraperitoneal Doses of Vancomycin in Continuous Ambulatory Peritoneal Dialysis Patients

Abstract

Eight patients with end-stage renal failure on continuous ambulatory peritoneal dialysis (CAPD), who developed peritonitis, received an intraperitoneal dose of vancomycin (30 mg/kg body weight) with 6 h of peritoneal dwell and then resumed their routine CAPD schedule. Vancomycin concentration in serum, peritoneal dialysate (PD) from an overnight dwell and 1, 2 and 3 h after a new exchange was measured at 48 h (in 5 patients) and 7 days (in 6 patients). Except for an occasional 1-hour peritoneal fluid sample on the 7th day, all samples had satisfactory vancomycin levels. Five of the 8 patients who had gram-positive peritonitis and 1 with ‘sterile’ peritonitis received another similar intraperitoneal dose of vancomycin at the 7th day. All of these patients had good therapeutic response with a negative PD culture 3 weeks after the cessation of therapy and no relapse of infection in at least 1 month of follow-up. We conclude that 2 intraperitoneal doses of vancomycin (30 mg/kg body weight) given 1 week apart with 6 h of intraperitoneal dwell is an effective and adequate treatment for gram-positive and ‘sterile’ peritonitis in CAPD patients.

Intraperitoneal Route for Vancomycin in CAPD Patients

“…In short, we think that the tobramycin and vancomy cin dosages recommended by Bastani et al [1] may be toxic, all the more when both drugs are associated and frequently used. On the other hand, we agree upon the necessity of using two antibiotics right from the start of the treatment in order to rapidly control infection before knowing the responsible germ.…”

Development and treatment of peritonitis in continuous ambulatory peritoneal dialysis

“…This was echoed by Bastini et a1 57 and Boyce et a1 " who, by means of a comparative study involving 51 patients, concluded that vancomycin once weekly for two weeks was as effective and safe as conventional continuous dosing.…”

“…Morse et al, 55 after initial pharmacokinetic studies, recommended a single 30mg/kg dose of vancomycin once weekly for three weeks." This was echoed by Bastini et a1 57 and Boyce et a1 " who, by means of a comparative study involving 51 patients, concluded that vancomycin once weekly for two weeks was as effective and safe as conventional continuous dosing.…”

Vancornycin in Peritoneal Dialysis‐Associated Peritonitis

“…Therefore, after i.v. administration of vancomycin to a CAPD patient, serum concentrations may remain elevated for prolonged periods, leading to a dosing interval of about 5 to 7 days in anuric patients (12,13,25). Once-weekly dosing is therefore adequate in such patients for even the most serious deep tissue infections.…”

“…administration, and a variety of different i.p. vancomycin regimens and doses have been advocated (10)(11)(12)(13)(14)(15)(16)(17)(18). In 1993 the Ad Hoc Committee proposed initial therapy for CAPD peritonitis to include vancomycin 2 grams i.p.…”