Analysis on Results of Blood Concentration Monitoring of Vancomycin by Intraperitoneal Administration in the Treatment of Peritoneal Dialysis-Related Peritonitis
OBJECTIVE:To analyze the dosage regimen and blood concentration monitoring of vancomycin by intraperitoneal administration for peritoneal dialysis-related peritonitis(PDRP)in Hainan General Hospital,and to probe into the correlation between blood concentration of vancomycin and clinical outcome.METHODS:Case data of 40 patients received vancomycin intraperitoneally with blood concentration monitoring in Hainan General Hospital from Jan.2020 to Apr.2023 were collected and analyzed in terms of the distribution of blood concentration of vancomycin,the first-time blood concentration levels of various regimens,adjustment of dosing regimens based on blood concentration,correlation between blood concentration and clinical outcome.RESULTS:(1)Among 69 cases of vancomycin blood concentration results,the blood concentration was mainly distributed in the range from 10 mg/L to 15 mg/L(28 cases,40.58%),with a mean concentration of(15.54±5.25)mg/L.During treatment,the numbers of patients who were monitored for once,twice and three or more times of blood concentration were respectively 20,15 and 5,of which successively 6,15 and 5 patients had adjusted vancomycin dosing regimen based on blood concentration.(2)And 0.5 g vancomycin was administered intraperitoneally qd,qod and q2d.The first blood concentration of the qd regimen was(17.11±4.43)mg/L,that of the qod regimen was(14.92±4.21)mg/L,and that of the q2d regimen was(11.27±2.66)mg/L,the difference in first blood concentrations between the qd regimen and the q2d regimen was statistically significant(P<0.01).(3)Using 15 mg/L as the boundary for grouping,the difference in the effective rates between high-concentration group and low-concentration group was not statistically significant(P>0.05);using 10 mg/L as the boundary for grouping,the effective rate of patients in the concentration<10 mg/L group was 25.00%(1/4),significantly lower than that 83.33%(30/36)in the concentration≥10 mg/L group,with statistically significant difference(P<0.05).CONCLUSIONS:There are large individual differences in the blood concentration of vancomycin by intraperitoneal administration,and it is recommended that the 0.5 g,qd regimen be preferred or a higher loading dose be given for the first dose,with the blood concentration maintained at≥10 mg/L.Blood concentration should be monitored dynamically in patients who have received multiple administrations and regimen adjustments.
Peritoneal dialysis-related peritonitisVancomycinTherapeutic drug monitoringBlood concentration
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