Vancomycin intraperitoneal

Metabolism/Excretion - In the first 24 hours, approximately 75% of a dose is excreted in urine by glomerular filtration. Elimination half-life is 4 to 6 hours in adults and 2 to 3 hours in children. About 60% of an intraperitoneal dose administered during peritoneal dialysis is absorbed systemically in 6 hours. Accumulation occurs in renal failure. Serum half-life in anephric patients is approximately 7.5 days. Vancomycin is not significantly removed by hemodialysis or continuous ambulatory peritoneal dialysis, although there have been reports of increased clearance with hemoperfusion and hemofiltration. 

Reports have revealed that administration of sterile vancomycin by the intraperitoneal route during continuous ambulatory peritoneal dialysis (CARD) has resulted in a syndrome of chemical peritonitis. This syndrome has ranged from a... 

FIGURE 7.1 Characterization of cell division inhibitor PC190723. (A) Chemical structure of PC190723. (B) In vivo efficacy of PC190723 in a murine model of infection. Mice were injected intraperitoneally (IP) with a lethal inoculum of S. aureus ATCC 19636 at time 0. One hour after infection the animals received 3 mg/kg (uneven dashed line), 10 mg/kg (dotted line), or 30 mg/kg (dark line) of PC190723 negative control (vehicle only, dashed black line) or 3 mg/kg of the vancomycin control antibiotic (thick dark line) by subcutaneous (SC, top) or intravenous (IV, bottom) administration. Mortality was recorded daily for 7 days. (Source From Haydon, DJ. et al. 2008. Science 321, 1673, 2008. Reprinted with permission from AAAS.)... 

Although the intraperitoneal administration of antibiotics offers a convenient and effective treatment alternative for PD-related peritonitis, potential toxicities should be considered. Chemical peritonitis is a potential toxicity associated with IP vancomycin therapy. A series of early reports of chemical peritonitis with vancomycin snggested that the problem may be brand-specific or associated with large doses (1 to 2 g). One prospective study suggested the incidence may be as high as 23% with IP doses of 1 g or more. There may be a hypersensitivity component to the effect, yet patients exhibiting chemical peritonitis have received subsequent doses without adverse effects. The exact etiology of vancomycin-associated chemical peritonitis remains to be clarified. IP amphotericin B also causes pain and chemical peritonitis. However, since IV amphotericin B poorly penetrates into the peritoneal cavity the therapeutic options are limited. ... 

Treatment of primary peritonitis for CARD patients should include an antistaphylococcal antimicrobial such as a first-generation cephalosporin or vancomycin (usually given by the intraperitoneal route). 

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