Abstract
The patients with CAPD peritonitis were treated by intravenous or intraperitoneal administration of vancomycin (VCM), which was isolated from Streptomyces orientalis and was known to be extremely effective for Gram positive bacteria. Seven patients (five males and two females) were submitted for this study. Concentrations of VCM in both serum and peritoneal fluid were measured by fluorescent polarization immunoassay (FPIA) for seven days following an intravenous administration of VCM (30mg/kg). Serum concentrations of VCM revealed sufficient therapeutic level for seven days after a single dose of VCM. Peritoneal clearance of VCM showed a tendency to decrease concomitatly with the improvement of peritonitis. In five patients, VCM was given intraperitoneally for 10 days with an initial dose of 200mg per 1, 500-2, 000ml CAPD fluid bag and then 100mg per bag. The bag was changed 6 times daily for the first two days and then 4 times daily until the 10th day. Balance studies of the drainage of CAPD fluid suggested that approxmately 70% of the VCM given intraperitoneally was absorbed and the serum concentration reached as high as therapeutic range within twenty-four hours after initiation of intraperitoneal VCM treatment. In all patients, symptoms of peritonitis disappeared within three days and cell counts in the dialysates became less than 100/mm3 within five days. Mild palpitation, Muscle pain and itching appeared in 3 of 5 patients during the intravenous administration of VCM. On the other hand, no obvious side effects occurred during the intraparitoneal treatment.
These results indicate that intravenous and intraparitoneal administration of VCM are safe and highlg effective in the treatment of CAPD peritonitis attributed to Gram positive organisms.
