Vancomycin disposition during continuous ambulatory peritoneal dialysis: a pharmacokinetic analysis of peritoneal drug transport

Abstract

Expressions are presented to describe the absorption and also clearance of drugs administered into the peritoneal cavity of patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Application of the expressions to vancomycin kinetics in five male CAPD patients showed that therapeutic levels of vancomycin can readily be achieved and maintained in the systemic circulation by administering the appropriate loading and maintenance doses. The intrinsic peritoneal clearance of vancomycin reported here is higher than the apparent clearances reported previously, averaging 300 to 500 ml/min under the conditions used in this study. The low apparent clearances previously reported are useful clinically although they do not represent the true efficiency of vancomycin removal by CAPD. The degree to which apparent clearance underestimates the true intrinsic clearance is exponentially related to the dwell time of dialysate in the peritoneum. Intraperitoneal administration is a practical alternative to other routes for CAPD patients needing antibiotic or other therapy.

Intravenous or Intraperitoneal Vancomycin for the Treatment of Continuous Ambulatory Peritoneal Dialysis Associated Gram-Positive Peritonitis?

“…This finding concurs with those of other workers [8][9][10], In addition, all cases of peritonitis were cured. It should therefore be unnecessary to administer vancomycin IV in these situations.…”

Effect of vancomycin hydrochloride on Staphylococcus epidermidis biofilm associated with silicone elastomer

“…Subsequently, the biomaterial-adherent biofilm was exposed to 25 ,ug of vancomycin hydrochloride per ml for 10 days to evaluate the ability of this antibiotic to kill the biofilmencased bacteria. There is still considerable controversy about the preferred route of administration of vancomycin in continuous ambulatory peritoneal dialysis-associated peritonitis (1,4,19,32). However, average concentrations of dialysate vancomycin reported in the scientific literature, irrespective of the therapeutic regime selected, range from 1 to 10 ,ug/ml, with peaks that usually do not exceed 25 ,g/ml.…”

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

“…Recent studies examined the pharmacokinetics of intravenous and intraperitoneal vancomycin in patients undergoing CAPO (Bastani et al 1988; Morse et al 1987;Neal & Bailie 1990). Studies have also examined the influence of intraperitoneal loading doses on serum vancomycin concentrations (Bailie et al 1987;Rogge et al 1985). However, the rate of increase in serum concentrations following an intraperitoneal loading dose is unclear and there are few data concerning the prediction of serum concentrations following intraperitoneal loading doses.…”

“…where t is the duration of the exchange (Rogge et al 1985). The predicted and actual measured serum concentrations were compared.…”