Efficacy of intravenous vancomycin in the treatment of gram-positive peritonitis in long-term peritoneal dialysis

Krothapalli, R. K.; Senekjian, H. O.; Avus, Juan C.

doi:10.1016/0002-9343(83)91215-9

Cited by 51 publications

(14 citation statements)

References 8 publications

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“…1) Although the pharmacokinetics and peritoneal dialysis clearance of vancomycin in patients undergoing chronic intermittent peritoneal dialysis have been thoroughly investigated (2,12,14,17), only limited information is available regarding the impact of CAPD on the pharmacokinetics of vancomycin (4,18). After a single 1-gm intraperitoneal dose was administered to four patients, Pancorbo and Comty (18) reported that ca.…”

Section: Resultsmentioning

confidence: 99%

“…50% are due to staphylococcal species (P. K. Peterson, and W. F. Keane, in J. S. Remington and M. N. Swartz, ed., Current Clinical Topics in Infectious Diseases, in press). Clinical effectiveness of vancomycin against staphylococci is well documented (1,5,7,9,14). The MICs of vancomycin have ranged from 0.63 to 3.12 mg/liter for Staphylococcus aureus and from 1.56 to 3.12 mg/liter for Staphylococcus epidermidis (6,8,10,16).…”

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confidence: 99%

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Pharmacokinetics of vancomycin in patients undergoing continuous ambulatory peritoneal dialysis

Blevins¹,

Halstenson²,

Salem³

et al. 1984

Antimicrob Agents Chemother

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The pharmacokinetics of vancomycin were studied in four patients on continuous ambulatory peritoneal dialysis. After a single intravenous infusion of 10 mg/kg of total body weight, multiple blood, urine, and dialysate samples were collected during a 72-h evaluation period. The steady-state volume of distribution was 0.73 ± 0.07 (mean ± standard deviation) liters/kg with a beta half-life of 90.2 ± 24.2 h. The continuous ambulatory peritoneal dialysis clearance of vancomycin was 1.35 ± 0.35 ml/min, and the serum clearance was 6.4 ± 1.1 ml/min. Peritoneal dialysate concentrations of vancomycin were rapidly attained after the intravenous infusion and averaged 2.2 ± 0.7 mg/liter throughout the 72-h observation period. A loading dose of 23 mg/kg followed by a maintenance dose of 17 mg/kg every 7 days should attain and maintain therapeutic serum and dialysate concentrations. More frequent dosing may be necessary for less susceptible organisms.Continuous ambulatory peritoneal dialysis (CAPD) is a self-dialysis procedure which is now widely used for the management of end-stage renal disease. The most frequent complication of CAPD is peritonitis. Over 65% of these infections are caused by gram-positive organisms, and ca. 50% are due to staphylococcal species (P. K. Peterson, and W. F. Keane, in J. S. Remington and M. N. Swartz, ed., Current Clinical Topics in Infectious Diseases, in press). Clinical effectiveness of vancomycin against staphylococci is well documented (1,5,7,9,14). The MICs of vancomycin have ranged from 0.63 to 3.12 mg/liter for Staphylococcus aureus and from 1.56 to 3.12 mg/liter for Staphylococcus epidermidis (6,8,10,16). Thus, vancomycin could be an extremely useful antibiotic for the management of infections in the CAPD patient.The pharmacokinetics of intravenously administered vancomycin in patients undergoing CAPD have, until recently, not been rigorously evaluated (4). The purpose of this study was to assess vancomycin concentrations in serum, periotoneal dialysate fluid, and urine after administration of a single intravenous dose. The pharmacokinetic parameters determined are as follows: elimination rate, elimination halflife, volume of distribution, total body clearance, and peritoneal clearance.MATERIALS AND METHODS Patients. Four patients (two males and two females) with end-stage renal disease undergoing CAPD gave written, informed consent to participate in this study. All patients had been on CAPD for at least 2 months (range, 2 to 14 months), and none had experienced peritonitis in the previous 2 months. Patients requiring systemic antibiotic therapy or who had a known allergy to vancomycin were excluded. Each patient had a physical examination and a laboratory screening profile done before and after they were studied.All patients had an indwelling Tenckhoff catheter in place. The CAPD exchange schedule for all patients was 2 liters of * Corresponding author. 2.5% glucose peritoneal dialysis solution (PD I; TravenolLaboratories, Deerfield, Ill.) four times a day. An intravenous catheter was ...

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Pharmacokinetics of vancomycin in patients undergoing continuous ambulatory peritoneal dialysis

Blevins¹,

Halstenson²,

Salem³

et al. 1984

Antimicrob Agents Chemother

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“…vancomycin administration to CAPD patients described a low plasma clearance with a prolonged serum half-life (2,4), and although onceweekly i.v. dosing is advocated by some (10), detailed studies of vancomycin kinetics over a 1-week period after a single dose have not been conducted. Studies on intraperitoneal (i.p.)…”

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confidence: 99%

Comparative study of intraperitoneal and intravenous vancomycin pharmacokinetics during continuous ambulatory peritoneal dialysis

Morse¹,

Farolino²,

Apicella³

et al. 1987

Antimicrob Agents Chemother

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The pharmacokinetic characteristics of vancomycin were investigated in eight patients undergoing continuous ambulatory peritoneal dialysis. A crossover design was used. Four noninfected patients received both a 15-mg/kg (body weight) intravenous dose and a 30-mg/kg intraperitoneal (i.p.) dose. Bioavailability ranged from 0.35 to 0.65 after i.p. administration. i.p. absorption was rapid, with concenttrations in serum of 8.8 ± 6 ,ug/ml noted at-1 h and peak values of 30.4 ± 7 ,ug/ml at 6 h. A slow distribution phase was apparent, with a terminal eliminatioli phase emnerging after 12 to 24 h. Vancomycin was eliminated slowly, with a mean total clearance of 5.0 ± 1.3 ml/min, and concentrations in serum were 7.0 ± 1.2 ,ug/ml at 168 h. The mean serum half-life was 91.7 ± 28.1 h, and similar pharmacokinetics were noted after intravenous administration. Subsequently, four patients with catheter-related exit site or tunnel infections received a 30-mng/kg i.p. dose of vancomycin and displayed a similar kinetic pattern. This method of administering vancomycin achieved therapeutic serum and end-dwell dialysate concentrations over a 1-week period, represents a simple, cost-effective therapy which avoids the possibility of infusion-related toxicity, and deserves further investigation in patients with continuous ambulatory peritoneal dialysis-related peritonitis.

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“…Recently, we have reported cases of CAPDrelated peritonitis caused by pathogens rarely associated with this condition (7,15,18). For CAPD-related peritonitis associated with Streptococcus and Enterococcus species, these bacteria account for about 10 to 15% of the total number of cases (5,6,9). Most of these cases were associated with Enterococcus faecalis or viridans group streptococci.…”

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Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis Associated with Lancefield Group G Beta-Hemolytic Streptococcus: Report of Two Cases Requiring Tenckhoff Catheter Removal

et al. 2004

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We describe the first two cases of continuous ambulatory peritoneal dialysis-related peritonitis associated with Lancefield group G beta-hemolytic streptococci in the literature. Both patients presented with abdominal pain and turbid dialysis effluent with or without fever. Both had concomitant gastrointestinal tract disturbance. Both did not respond to intraperitoneal cefazolin and tobramycin and required removal of the Tenckhoff catheters. CASE REPORTSCase 1. A 38-year-old Chinese woman was admitted to the hospital in November 2003 because of abdominal pain and cloudy dialysis effluent for 1 day. She had a history of end stage renal disease as a result of hypertensive nephrosclerosis, for which continuous ambulatory peritoneal dialysis (CAPD) had commenced 6 years ago. She had an episode of Pseudomonas aeruginosa peritonitis in 1999, which required removal and reinsertion of the Tenckhoff catheter. She had 3 days of constipation prior to the development of abdominal pain and cloudy dialysis effluent. On admission, she was afebrile with generalized abdominal tenderness and turbid dialysis effluent. The hemoglobin was 7.2 g/dl; the total white cell count was 17.2 ϫ 10 9 /liter, with a neutrophil count of 15.0 ϫ 10 9 /liter, a lymphocyte count of 0.7 ϫ 10 9 /liter, a monocyte count of 1.3 ϫ 10 9 /liter, and an eosinophil count of 0.2 ϫ 10 9 /liter; and the platelet count was 376 ϫ 10 9 /liter. The serum urea and creatinine levels were 26.2 mmol/liter and 1,110 mol/liter, respectively, with normal levels of liver enzymes except an elevated alkaline phosphatase level of 164 U/liter. The total leukocyte count of the dialysis fluid was 3,315 ϫ 10 6 /liter. A Gram stain of the dialysis effluent after centrifugation revealed only numerous leukocytes; no microorganisms were seen. Intraperitoneal cefazolin and tobramycin were started for empirical treatment of CAPD peritonitis.Culture of the dialysis effluent obtained on admission yielded pure growth of a gram-positive coccus in chains. It appeared on horse blood agar as beta-hemolytic, white, smooth colonies 1 mm in diameter after incubation at 37°C in 5% CO 2 for 24 h. It did not grow on MacConkey agar. The isolate was catalase negative. Lancefield serogrouping with Streptex (Murex Biotech Ltd., Dartford, United Kingdom) revealed that it was group G. It was identified as Streptococcus dysgalactiae by the Vitek GPI system (bioMerieux Vitek, Hazelwood, Mo.) with Ͼ99% confidence. 16S rRNA gene sequencing, using primers and the protocol described in our previous publication (16) and Streptococcus pyogenes (ATCC 19615) as the control, showed that it was S. dysgalactiae subsp. equisimilis. The isolate was sensitive to penicillin, erythromycin, clindamycin, and vancomycin.The patient did not respond to cefazolin and tobramycin, which were stopped on day 4, and intraperitoneal vancomycin and amikacin were commenced. As the response was still unsatisfactory after another 4 days, intravenous ceftazidime and amikacin were commenced and the Tenckhoff catheter was removed. The two...

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Efficacy of intravenous vancomycin in the treatment of gram-positive peritonitis in long-term peritoneal dialysis

Cited by 51 publications

References 8 publications

Pharmacokinetics of vancomycin in patients undergoing continuous ambulatory peritoneal dialysis

Pharmacokinetics of vancomycin in patients undergoing continuous ambulatory peritoneal dialysis

Comparative study of intraperitoneal and intravenous vancomycin pharmacokinetics during continuous ambulatory peritoneal dialysis

Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis Associated with Lancefield Group G Beta-Hemolytic Streptococcus: Report of Two Cases Requiring Tenckhoff Catheter Removal

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