Vancomycin pharmacokinetics in patients with peritonitis on peritoneal dialysis

Magera, B E; Arroyo, Julio C.; Rosansky, Steven J.; Postic, Boško

doi:10.1128/aac.23.5.710

Cited by 47 publications

(23 citation statements)

References 11 publications

(5 reference statements)

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“…This value differs from that of 6.42 ± 1.10 ml/min (SD) observed by Blevinset al [13] and that of 9.4 ±1.9 ml/min (SE) noted by Bunke et al [14], though both of these determinations were obtained dur ing a study of noninfected patients. The TBC of the drug that we observed closely approximated that found by Mageraet al [11], which was4.25 ±0.61 ml/min (SD). The study by Magera et al [11], although performed during intermittent peritoneal dialysis, relates most closely to our study, since it was also performed in infected pa tients.…”

Section: Discussionsupporting

confidence: 78%

“…The TBC of the drug that we observed closely approximated that found by Mageraet al [11], which was4.25 ±0.61 ml/min (SD). The study by Magera et al [11], although performed during intermittent peritoneal dialysis, relates most closely to our study, since it was also performed in infected pa tients. In attempting to interpret TBC values for vanco mycin, one should be cognizant of the ability of residual renal function to serve as an additional drug clearance determinant despite the presence of end-stage renal dis ease.…”

Section: Discussionsupporting

confidence: 78%

“…When vancomycin has been used, many authors have suggested that both intravenous and intraperitoneal therapy be employed because of the limited diffusibility of this drug [5,14]. In contrast to these studies, a number of reports have demonstrated the ready entry of vanco mycin into peritoneal fluid, particularly in the setting of peritonitis [10,11]. Despite some controversy regarding the ability of vancomycin to cross the peritoneal mem brane, it has been demonstrated by some centers to be an effective first-line agent in the management of gram-posi tive peritonitis [19].…”

Section: Discussionmentioning

confidence: 99%

“…The magnitude of vancomycin's half-life extension in renal failure is such that once weekly dosing frequently constitutes adequate therapy for infections caused by susceptible gram-positive organisms. Although studies of a similar nature have been repeated in peritoneal dialysis patients, many of these have involved intermit tent peritoneal dialysis rather than CAPD [8][9][10][11]. Though an increasing number of CAPD studies have been com pleted, almost all of these studies have utilized noninfected patients [12][13][14].…”

mentioning

confidence: 99%

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Vancomycin Pharmacokinetics in Continuous Ambulatory Peritoneal Dialysis Patients with Peritonitis

Harford¹,

Sica²,

Tartaglione³

et al. 1986

Nephron

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Peritonitis has proven to be the major deterrent to the further growth of continuous ambulatory peritoneal dialysis (CAPD) as a treatment strategy for end-stage renal disease. The correct treatment of peritonitis remains unsettled as evidenced by the presence of advocates for oral, intravenous or intraperitoneal antibiotic administration. This study examines the pharmacokinetic parameters of intravenous vancomycin when employed in the therapy of peritonitis. One gram of intravenous vancomycin was administered during 7 episodes of peritonitis in 5 patients. Plasma and end-of-dwell dialysate levels were maintained above the minimum inhibitory concentration for Staphylococcus aureus and S. epidermidis for 7 days following this single dose of vancomycin. These data establish the existence of sustained intraperitoneal entry of intravenous vancomycin during peritonitis and raise for speculation its use as the sole therapy in most episodes of gram-positive peritonitis.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Vancomycin Pharmacokinetics in Continuous Ambulatory Peritoneal Dialysis Patients with Peritonitis

Harford¹,

Sica²,

Tartaglione³

et al. 1986

Nephron

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“…administration of vancomycin, a slow distribution phase was apparent. This delayed period of distribution was previously described in patients with normal renal function (3,6,9); however, it seems that patients with end-stage renal disease have an even more prolonged distribution phase (2,4,5,11 …”

Section: Discussionmentioning

confidence: 80%

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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Vancomycin: An Update

Cheung

DiPiro

1986

Pharmacotherapy

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Vancomycin is a narrow-spectrum glycopeptide antibiotic with potent antistaphylococcal activity. It is primarily active against gram-positive organisms. Bacterial resistance rarely develops due to its numerous modes of action. The toxic potential of vancomycin is less significant than previously thought. "Red neck syndrome" seems to be the most common side effect and appears to be caused by rapid intravenous infusion. It is characterized by erythema at the base of the neck and the upper back; hypotensive episodes may also occur. Nephrotoxicity and ototoxicity are rare. Relationships between toxicities and serum concentrations have not been established. The disposition of vancomycin after intravenous administration proceeds biphasically--rapid distribution followed by elimination. The drug is excreted primarily unchanged in the urine by glomerular filtration. Vancomycin clearance is reduced and elimination half-life is prolonged in patients with renal insufficiency. Various methods have been published to aid in dosing the drug in these patients. Vancomycin is the drug of choice in the treatment of methicillin-resistant staphylococcal infections. It is also useful in the treatment of gram-positive endocarditis and has been used as alternative therapy in the treatment of prophylaxis of gram-positive infections in penicillin-allergic patients. Oral vancomycin is the preferred therapy in antibiotic-associated colitis.

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Vancomycin pharmacokinetics in patients with peritonitis on peritoneal dialysis

Cited by 47 publications

References 11 publications

Vancomycin Pharmacokinetics in Continuous Ambulatory Peritoneal Dialysis Patients with Peritonitis

Vancomycin Pharmacokinetics in Continuous Ambulatory Peritoneal Dialysis Patients with Peritonitis

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

Vancomycin: An Update

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