Titre
Vancomycin Dosing Strategy for the Treatment of Peritonitis in a Child on Automated Peritoneal Dialysis: A First Pediatric Case Report.
Type
étude de cas
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Haefliger, D.
Auteure/Auteur
Chehade, H.
Auteure/Auteur
Livio, F.
Auteure/Auteur
Rodrigues-Veiga, V.
Auteure/Auteur
Diezi, L.
Auteure/Auteur
Marzolini, C.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
1525-139X
Statut éditorial
Publié
Date de publication
2024
Volume
37
Numéro
6
Première page
461
Dernière page/numéro d’article
465
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Case Reports ; Journal Article
Publication Status: ppublish
Publication Status: ppublish
Résumé
Bacterial peritonitis is a common complication of peritoneal dialysis. In the absence of systemic signs of infection, adult guidelines recommend treatment with intraperitoneal vancomycin either as empiric coverage of gram-positive organisms or as targeted therapy. However, there is no guidance on how to administer vancomycin in children on automated peritoneal dialysis.
We report vancomycin pharmacokinetics upon intraperitoneal administration for the treatment of a Staphylococcus hominis peritonitis in an 11-year-old patient on automated nocturnal intermittent peritoneal dialysis. While the patient was hospitalized, vancomycin was administered intraperitoneally as a continuous treatment. After hospital discharge, the nocturnal peritoneal dialysis was resumed. In the absence of treatment guidelines, intraperitoneal vancomycin was initially administered empirically only during the nocturnal dialysis exchanges which led to repetitive subtherapeutic vancomycin plasma concentrations and the persistence of S. hominis in dialysate cultures. Based on studies in adults, the dosing strategy was subsequently modified to administer vancomycin at a dosage of 15 mg kg <sup>-1</sup> in the dialysate with a 6-h dwell period prior to the nocturnal dialysis thereby allowing to reach optimal peak concentrations. The dosing interval was subsequently individualized using therapeutic drug monitoring to ensure residual vancomycin concentrations > 10 mg L <sup>-1</sup> thereby leading to clinical and microbiological recovery.
This case presents a dosing strategy based on a comprehensive review of the literature and highlights that a sufficient dwell period is critical when treating pediatric patients on automated peritoneal dialysis in order to allow vancomycin distribution and equilibration between the dialysate and the plasma.
We report vancomycin pharmacokinetics upon intraperitoneal administration for the treatment of a Staphylococcus hominis peritonitis in an 11-year-old patient on automated nocturnal intermittent peritoneal dialysis. While the patient was hospitalized, vancomycin was administered intraperitoneally as a continuous treatment. After hospital discharge, the nocturnal peritoneal dialysis was resumed. In the absence of treatment guidelines, intraperitoneal vancomycin was initially administered empirically only during the nocturnal dialysis exchanges which led to repetitive subtherapeutic vancomycin plasma concentrations and the persistence of S. hominis in dialysate cultures. Based on studies in adults, the dosing strategy was subsequently modified to administer vancomycin at a dosage of 15 mg kg <sup>-1</sup> in the dialysate with a 6-h dwell period prior to the nocturnal dialysis thereby allowing to reach optimal peak concentrations. The dosing interval was subsequently individualized using therapeutic drug monitoring to ensure residual vancomycin concentrations > 10 mg L <sup>-1</sup> thereby leading to clinical and microbiological recovery.
This case presents a dosing strategy based on a comprehensive review of the literature and highlights that a sufficient dwell period is critical when treating pediatric patients on automated peritoneal dialysis in order to allow vancomycin distribution and equilibration between the dialysate and the plasma.
PID Serval
serval:BIB_31FDA1A2A806
PMID
Open Access
Oui
Date de création
2024-08-30T13:23:54.410Z
Date de création dans IRIS
2025-05-20T14:23:59Z
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Nom
39174700 .pdf
Version du manuscrit
published
Licence
https://creativecommons.org/licenses/by-nc/4.0
Taille
523.2 KB
Format
Adobe PDF
PID Serval
serval:BIB_31FDA1A2A806.P001
URN
urn:nbn:ch:serval-BIB_31FDA1A2A8066
Somme de contrôle
(MD5):ac6e34afa423ebc04f868c3e246bc6b1