Trough serum vancomycin levels predict the relapse of gram-positive peritonitis in peritoneal dialysis patients

The Role of Monitoring Vancomycin Levels in Patients with Peritoneal Dialysis-Associated Peritonitis

“…However, the initial empiric vancomycin dose administered in this study (15 mg/kg to a maximum of 1 g IP) was considerably lower than that (7) and Mulhern et al (6) targeted trough serum vancomycin concentrations greater than 12 mg/L, the present study aimed to maintain trough serum vancomycin levels above 15 mg/L. The ISPD Guidelines for the treatment of peritoneal dialysis-associated infections recommend that vancomycin should be administered in a dose of 15 -30 mg/kg IP with further doses repeated every 5 -7 days in continuous ambulatory PD or 3 -5 days in APD with the aim of maintaining trough serum vancomycin levels above 15 mg/L (4).…”

“…In contrast, Mulhern et al (6) observed in 31 episodes of gram-positive peritonitis that a heightened risk of peritonitis relapse was associated with an initial 7-day trough serum vancomycin level < 9 mg/L or a cumulative 4-week trough < 12 mg/L. However, the initial empiric vancomycin dose administered in this study (15 mg/kg to a maximum of 1 g IP) was considerably lower than that (7) and Mulhern et al (6) targeted trough serum vancomycin concentrations greater than 12 mg/L, the present study aimed to maintain trough serum vancomycin levels above 15 mg/L.…”

“…In a retrospective investigation of 31 episodes of gram-positive PD peritonitis, Mulhern et al (6) observed that a cumulative 4-week trough serum vancomycin level < 12 mg/L or an initial 7-day trough serum level < 9 mg/L predicted significantly increased risks of peritonitis relapse. In contrast, Blunden et al (7) reported that day-5 vancomycin levels did not predict cure or relapse inPress PDI of gram-positive or culture-negative peritonitis in 374 PD patients and that increasing vancomycin concentrations did not appear to improve cure rates.…”

Vancomycin: The Tale of the Vanquisher and the Pyrrhic Victory

“…In another study of gram-positive peritonitis, relapses developed in 9 of 14 peritonitis episodes with a mean vancomycin trough level of less than 12 mg/L; no relapses occurred in 17 episodes with a trough level greater than 12 mg/L (40). A low initial vancomycin trough level was the only predictor of subsequent relapsed peritonitis (41). These mixed clinical outcomes data warrant scrutiny of the guidelines for vancomycin administration presented by the ISPD.…”

Controversies in the Management of Infective Complications of Peritoneal Dialysis

“…Adjustment of empirical doses to target therapeutic serum levels of glycopeptides or aminoglycosides allows for pharmocokinetics made more complex by modality and individual variation in residual renal function. Mulhern et al [22] reviewed 31 episodes of Gram-positive PDP between 1990 and 1993. They pursued a strategy of targeting a vancomycin level >12 mg/l, finding that mean trough levels were significantly lower in episodes complicated by a relapse.…”