Abstract
Red man syndrome (RMS) has frequently been reported to occur with intravenous vancomycin therapy. However, there have been few reports of this complication during intraperitoneal (IP) treatment with vancomycin. This report describes an 11-year-old boy with end stage renal disease who developed RMS 45 min into the initial loading dose of IP vancomycin for the treatment of bacterial peritonitis with a vancomycin level of 38.8 mcg/mL. The patient developed this adverse reaction despite appropriate initial loading dose per ISPD guidelines for continuous treatment (1000 mg/L). This case emphasizes the importance of monitoring for adverse reactions of vancomycin therapy, and raises dosing considerations that differ slightly from the currently recommended ISPD guidelines for IP vancomycin treatment in the treatment of bacterial peritonitis.
Highlights
Bacterial peritonitis is one of the most frequent infectious complications of peritoneal dialysis with significant morbidity
The recommended initial IP vancomycin dose is a 1000 mg/L loading dose followed by 25 mg/L for maintenance therapy or 30 mg/kg as a loading dose followed by 15 mg/kg every 3–5 days for intermittent therapy (1)
We present the case of an 11-year-old boy who developed red man syndrome (RMS) shortly following the initial loading dose of vancomycin for the treatment of bacterial peritonitis
Summary
Bacterial peritonitis is one of the most frequent infectious complications of peritoneal dialysis with significant morbidity. CASE REPORT An 11-year-old 37.3 kg Amish boy with end-stage renal disease secondary to posterior urethral valves managed with continuous ambulatory peritoneal dialysis (CAPD) for 2 years presented to the hospital for the evaluation of peritonitis due to cloudy peritoneal fluid. His CAPD prescription consisted of four exchanges with a fill volume of 1400 mL of 1.5% Dianeal. Cultures subsequently grew coagulase-negative Staphylococcus and Enterococcus faecalis, without clinical evidence of peritonitis, which was successfully treated with 500 mg (13 mg/kg) of intermittent IP vancomycin He had no reaction to the IP vancomycin, and he had no previous medication allergies.
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