title: Intraperitoneal vancomycin concentrations during peritoneal dialysis-associated peritonitis: correlation with serum levels.
abstract: BACKGROUND
  For the treatment of peritoneal dialysis-associated peritonitis (PDP), it has been suggested that serum concentrations of vancomycin be kept above 12 mg/L-15 mg/L. However, studies correlating vancomycin concentrations in serum and peritoneal dialysate effluent (PDE) during active infection are sparse. We undertook the present study to investigate this issue and to determine whether achieving the recommended serum level of vancomycin results in therapeutic levels intraperitoneally.
  
  
  METHODS
  We studied patients treated with intraperitoneal (i.p.) vancomycin for non-gram-negative PDP. We gave a single dose (approximately 30 mg/kg) at presentation, and we subsequently measured vancomycin levels in PDE on day 5; we wanted to determine if efflux of vancomycin from serum to PDE during a 4-hour dwell was consistent and resulted in therapeutic levels.
  
  
  RESULTS
  Of the 48 episodes of PDP studied, serum vancomycin concentrations exceeding 12 mg/L were achieved in 98% of patients, but in 11 patients (23%), a PDE vancomycin level below 4 mg/L--the minimal inhibitory concentration (MIC) of many gram-positive organisms--was observed at the end of a 4-hour dwell on day 5. The correlation between the concentrations of vancomycin in serum and PDE (from efflux of antibiotic over 4 hours) was statistically significant, but poor (R(2) = 0.18).
  
  
  CONCLUSIONS
  Our data support the International Society for Peritoneal Dialysis statement that adequate serum vancomycin concentrations can be achieved with intermittent dosing (single dose every 5 days), but cannot guarantee therapeutic PDE levels in the treatment of PDP. Intermittent dosing of vancomycin may not consistently result in PDE concentrations markedly greater than MIC of many important pathogens. Although the clinical significance of this finding remains to be determined, it may be preferable to give smaller but more frequent doses of PDE vancomycin (continuous dosing) for adults with PDP (as is currently recommended for children).
authors: Department of Renal Medicine and Transplantation, The Royal London Hospital, London, UK.
authors: Richard
authors: R
authors: Fish
authors: Robert
authors: R
authors: Nipah
authors: Chris
authors: C
authors: Jones
authors: Hazel
authors: H
authors: Finney
authors: Stanley L S
authors: SL
authors: Fan
mesh_terms: D000900:Anti-Bacterial Agents / Q000032:analysis* / Q000097:blood / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects; D010537:Peritoneum / Q000378:metabolism*; D010538:Peritonitis / Q000097:blood / Q000378:metabolism* / Q000382:microbiology*; D012189:Retrospective Studies; D014640:Vancomycin / Q000032:analysis* / Q000097:blood / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin