Peritoneal clearance and total body elimination of vancomycin during chronic intermittent peritoneal dialysis

Vancomycin is a useful antimicrobial agent in patients undergoing chronic hemodialysis treatment; its efficacy in chronic peritoneal dialysis (CPD) has not been established. Serum (V(S)) and peritoneal fluid (V(PF)) vancomycin concentrations were measured in two CPD patients with staphylococcal peritonitis. Half-life of V(S) agreed with the half-life of V(PF) in each patient and the V(S)/V(PF) ratio was 1.27 in both patients. Distribution volumes were 37.2 and 58.7 l, values approximating total body water in these patients. V(S) and V(PF) persisted in the therapeutic range (>5 μg/ml) for more than 16 days. In one patient, mean peritoneal clearance was 9.8 ml/min and overall drug clearance averaged 2.3 ml/min; in the other patient, overall clearance was 2.1 ml/min. These results indicate that therapeutic vancomycin levels can be maintained for more than 16 days with a single 1 g intravenous dose in patients receiving intermittent CPD, as is the case for hemodialysis patients. Because of this, parenteral vancomycin is useful in the treatment of staphylococcal peritonitis in CPD patients.