Prediction of Serum Vancomycin Concentrations Following Intraperitoneal Loading Doses in Continuous Ambulatory Peritoneal Dialysis Patients with Peritonitis

Abstract

The pharmacokinetics of vancomycin were studied in continuous ambulatory peritoneal dialysis patients with peritonitis. Six patients received an intraperitoneal loading dose of 15 mg/kg and 4 received an intraperitoneal dose of 25 mg/L. The ability of 2 methods to predict serum concentrations during the loading dose exchange was determined. The mean serum concentration after the exchange was 17.8 +/- 2.2 mg/L in patients receiving the loading dose. The mean dialysis clearance in all patients was 0.94 +/- 0.34 L/h. 66.6 +/- 13.4% of a dose was absorbed into the circulation in 4 h. The volume of distribution was 0.61 +/- 0.46 L/kg, and the half-life for equilibration of vancomycin into the circulation from dialysate was 2.76 +/- 0.94 h. Two methods of predicting serum vancomycin concentrations were tested, with 1 method predicting values significantly different from measured concentrations while the other did not. Serum vancomycin concentrations can be accurately predicted during a loading dose exchange.

Vancomycin in peritoneal dialysis: Clinical pharmacology considerations in therapy

“…Following intraperitoneal dosing, vancomycin equilibration half-life in patients on CAPD without peritonitis was 2.9 hours and those with peritonitis 1.6-2.9 hours. (18)(19)(20) Assuming no differences between peritoneum transport in those with or without peritonitis and five half-lives, steady-state equilibrium between the dialytic compartment and systemic circulation would be achieved following a 10-15 hour dwell.…”

“…(38) Regardless of the PD modality, absorption does not largely change between CAPD or APD based on the equilibration half-lives reported. (12,19,20) In patients with PD peritonitis on APD, doses of 15-20 mg/kg together with dwell times ranging from 10-15 hours may be more appropriate than the targeted concentration strategy mentioned above.…”

Vancomycin: The Tale of the Vanquisher and the Pyrrhic Victory

“…Vancomycin has a molecular weight of approximately 1500 Da (30). After intraperitoneal administration, 30% -70% of the dose will be absorbed into the systemic circulation at the end of a 4-to 6-hour dwell, regardless of whether the peritoneal membrane is inflamed (42)(43)(44)(45)(46)(47)(48)(49)(50). Those data provide support for the recommendation that antibiotic-containing dialysate must dwell at least 4 hours to ensure an adequate antibiotic reservoir in the body (37).…”

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.…”

“…Intraperitoneal doses of 1 to 2 G widely used since their recommendation by the Ad Hoc Committee (3) and have been carefully studied ( 1 1 , 12,25,33 self-administration; intermittent administration (every 5 to 7 days); and the potential to treat systemic infections (46). In general, although the i.p.…”