Vancomycin kinetics during continuous ambulatory peritoneal dialysis

• Published in: Clinical pharmacology and therapeutics Vol. 34; no. 5; p. 631
• Main Authors: Bunke, C M, Aronoff, G R, Brier, M E, Sloan, R S, Luft, F C
• Format: Journal Article
• Language: English
• Published: United States 01.11.1983
• Subjects: Adult; Humans; Injections, Intraperitoneal; Injections, Intravenous; Kinetics; Middle Aged; Peritoneal Dialysis - adverse effects; Peritoneal Dialysis, Continuous Ambulatory - adverse effects; Peritonitis - drug therapy; Peritonitis - etiology; Vancomycin - metabolism; Vancomycin - therapeutic use
• ISSN: 0009-9236
• DOI: 10.1038/clpt.1983.225

To establish therapeutic guidelines for vancomycin usage in patients receiving continuous ambulatory peritoneal dialysis (CAPD), we studied single-dose kinetics of vancomycin in CAPD patients. Vancomycin was studied after a 10-mg/kg dose was given intravenously (VAN-IV) or intraperitoneally (VAN-IP). VAN-IV provided a plasma concentration above 10 mg/l at 12 hr, with a t 1/2 of 81 hr. When VAN-IP was given, 65% was absorbed; peak plasma concentrations were only 6.3 mg/l, and t 1/2 was 66 hr. CAPD accounted for only 15% to 17% of total body clearance in both groups. The kinetic principle of superposition was used to predict plasma concentrations after repeated VAN-IP doses. A model with once-a-day dosing predicted that a loading dose of 30 mg/kg followed by 7 mg/kg would achieve steady-state plasma concentrations of 11 to 14.8 mg/l. Another model with vancomycin in each exchange predicted that a loading dose of 30 mg/kg followed by 1.5 mg/kg would provide plasma concentrations in excess of 10 mg/l at 180 hr. These data should be useful in vancomycin treatment of CAPD patients who have nonperitoneal gram-positive bacterial infections, as well as those who have peritonitis.