Vancomycin kinetics during continuous ambulatory peritoneal dialysis

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Abstract
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 t½ of 81 hr. When VAN‐IP was given, 65% was absorbed; peak plasma concentrations were only 6.3 mg/l, and t½ 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 mglkg 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. Clinical Pharmacology and Therapeutics (1983) 34, 631–637; doi:10.1038/clpt.1983.225

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