Intravenous or intraperitoneal vancomycin for the treatment of continuous ambulatory peritoneal dialysis associated gram-positive peritonitis?

A clinical and pharmacokinetic study was carried out to determine whether an intraperitoneal (IP) loading dose of vancomycin was as effective as an intravenous (IV) load in the treatment of continuous ambulatory peritoneal dialysis (CAPD)-associated gram-positive peritonitis. Each patient continued a 14-day treatment on IP maintenance doses. All cases of peritonitis (10 in each group) were eradicated. Side effects occurred in 3 patients following IV vancomycin and in none following IP vancomycin. Serum and peritoneal vancomycin concentrations equilibrated fully and rapidly with each route. It is concluded that an IP loading dose of vancomycin, followed by IP maintenance doses, is as effective as and produces fewer side effects than an IV loading dose in the treatment of CAPD peritonitis.