Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA.
Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, FL, USA.
Perit Dial Int. 2020 Jul;40(4):384-393. doi: 10.1177/0896860819889774. Epub 2020 Feb 17.
Intraperitoneal vancomycin is the first-line therapy in the management of peritoneal dialysis (PD)-related peritonitis. However, due to the paucity of data, vancomycin dosing for peritonitis in patients on automated peritoneal dialysis (APD) is empiric and based on clinical experience rather than evidence. Studies in continuous ambulatory peritoneal dialysis (CAPD) patients have been used to provide guidelines for dosing and are often extrapolated for APD use, but it is unclear whether this is appropriate. This review summarizes the available pharmacokinetic data used to inform optimal dosing in patients on CAPD or APD. The determinants of vancomycin disposition and pharmacodynamic effects are critically summarized, knowledge gaps explored, and a vancomycin dosing algorithm in PD patients is proposed.
腹腔内万古霉素是腹膜透析（PD）相关腹膜炎治疗的一线药物。然而，由于数据有限，自动化腹膜透析（APD）患者的腹膜炎万古霉素剂量是经验性的，基于临床经验而不是证据。在持续非卧床腹膜透析（CAPD）患者中的研究已被用于提供剂量指南，并经常被外推用于 APD，但尚不清楚这是否合适。本综述总结了用于指导 CAPD 或 APD 患者最佳剂量的可用药代动力学数据。本文还批判性地总结了影响万古霉素处置和药效学的因素，探讨了知识空白，并提出了 PD 患者的万古霉素剂量算法。
