Toxicologic and pharmacokinetic evaluation of a case of vancomycin intoxication during continuous ambulatory peritoneal dialysis
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The use of vancomycin is rapidly increasing due to the emergence of strains of staphylococci resistant to betalactam antibiotics. In this communication the pharmacokinetics of an overdose of vancomycin in a patient during continuous ambulatory peritoneal dialysis (CAPD) is reported. Brainstem auditory evoked potentials (BAEPs) are used to assess ototoxicity. It could be shown that by shortening the dwell time, the apparent CAPD flow was increased and the vancomycin clearance was also increased. This may explain in part the differences in the values of vancomycint1/2 in this patient (21 h) as compared to other studies (60–120 h). The age of the patient (3.5 years) may also have influenced thet1/2. Using brainstem auditory evoked potentials as a parameter to assess ototoxicity, it was shown that this patient suffered no damage from the overdose.
Key wordsOtotoxicity Peritoneal dialysis, continuous ambulatory Pharmacokinetics Poisoning Vancomycin
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- 3.Lau T, Barriere SL. Vancomycin nephrotoxicity. Drug Intell Clin Pharm 1985; 19: 907–8.Google Scholar
- 8.Moellering RC. Pharmacokinetics of vancomycin. J Antimicrob Chemother 1984; 14(suppl D): 43–52.Google Scholar
- 13.Cunha BA, Quintiliani R, Deglin JM, Izard MW, Nightingale CH. Pharmacokinetics of vancomycin in anuria. Rev Infect Dis 1981; suppl 3: S269–72.Google Scholar
- 14.Pechere JC, Bernard PA, Ferron P, Rouillard R, Picard AC, Murray G. Assessment of minute aminoglycoside ototoxicity by evoked audiometry in humans. In: Periti P, Grassi GG eds. Current Chemotherapy and Immunotherapy. Proceedings of the 12th International Congress of Chemotherapy, Florence, Italy, 19–24, July, 1981. Washington: American Society for Microbiology, 1981: 843–4.Google Scholar
- 19.Golper T, Bennett W, Jones S. Peritonitis associated with chronic peritoneal dialysis. Dial Transplant 1978; 7: 1173–8.Google Scholar
- 20.Janknegt R, Koks CHW. Pharmacokinetic aspects during continuous ambulatory peritoneal dialysis: a literature review. Pharm Weekbl [Sci] 1984; 6: 229–36.Google Scholar
- 22.Matzke GR. Vancomycin. In: Evans E, Schentag JE, Jusko WJ, et al., eds., Applied Pharmacokinetics: principles of therapeutic drug monitoring. 2nd ed. Spokane: Applied Therapeutics Inc., 1986; 399–436.Google Scholar
- 23.Eggermont JJ. The inadequacy of click-evoked auditory brainstem responses in audiological applications. Ann NY Acad Sci 1982; 380: 707–9.Google Scholar