Abstract
Intraperitoneal vancomycin is the first-line therapy in the management of peritoneal dialysis (PD)-related peritonitis. However, due to the paucity of data, vancomycin dosing for peritonitis in patients on automated peritoneal dialysis (APD) is empiric and based on clinical experience rather than evidence. Studies in continuous ambulatory peritoneal dialysis (CAPD) patients have been used to provide guidelines for dosing and are often extrapolated for APD use, but it is unclear whether this is appropriate. This review summarizes the available pharmacokinetic data used to inform optimal dosing in patients on CAPD or APD. The determinants of vancomycin disposition and pharmacodynamic effects are critically summarized, knowledge gaps explored, and a vancomycin dosing algorithm in PD patients is proposed.
Highlights
Vancomycin is often selected as empiric first line therapy for suspected Gram-positive organisms in peritoneal dialysis (PD) related peritonitis
This review aims to summarize the available evidence on vancomycin pharmacokinetic and pharmacodynamic PD-related studies, address the physicochemical and PD modality-specific considerations- with attention on automated peritoneal dialysis (APD), and highlight areas where research is needed on dosing vancomycin for PD-related peritonitis
25% increase in antibiotic dose in patients with a daily urine output of over 100 mL.(31) This recommendation has been removed in the updated 2016 guideline, which reflects the lack of evidence to support this empiric recommendation.(29) In a retrospective study examining the impact of RESIDUAL KIDNEY FUNCTION (RKF) on vancomycin concentrations, the influence of RKF was found to not have a significant impact.(32)
Summary
Vancomycin is often selected as empiric first line therapy for suspected Gram-positive organisms in peritoneal dialysis (PD) related peritonitis. Data on vancomycin dosing in various PD modalities are limited, especially for automated peritoneal dialysis (APD). Vancomycin is a tricyclic glycopeptide antibiotic with broad spectrum activity against Grampositive bacteria. It is effective for the treatment of Gram-positive infections including peritonitis and is the drug of choice for methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin is poorly absorbed following oral administration. It is commonly administered as an intravenous infusion, except in peritoneal dialysis where the route is preferentially intraperitoneal.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
