Vancomycin reconsidered for peritoneal dialysis
Vancomycin reconsidered for peritoneal dialysis
Drug options limited
Peritoneal dialysis patients are often prone to staph infections, and vancomycin is one of the traditional first-line treatments of choice because of its efficacy and ease of administration. This widely accepted clinical approach resulted in the first confirmed infection with vancomycin intermediate-resistant Staphylococcus aureus (VISA) in the United States, but there may have been few options."In the setting of renal failure, whether hemodi alysis or peritoneal dialysis, staphylococcal infections are relatively common and vancomycin is so easy to use," explains William Schaffner, MD, professor of infectious diseases and chairman of the department of preventive medicine at the University of Vanderbilt School of Medicine in Nashville. Vancomycin can be administered in a single dose that lasts for days, particularly easing administration in home care patients.
If the infecting agent is methicillin-resistant S. aureus (MRSA), treatment options other than vancomycin are limited. The first U.S. VISA strain was eventually susceptible to rifampin, chloramphenicol, trimethoprim-sulfamethoxazole, and tetracycline. While that’s certainly a better scenario than a VISA strain impervious to other antimicrobials, the treatment options are not favorable. For example, Schaffner says rifampin should be used only in combination with other drugs for such infections, and tetracycline may actually worsen the course of staph infections even though the organism is susceptible.
"We would never use tetracycline to treat someone with staphylococcal infection," he says. "These [four] are not great drugs. And you run into all kinds of questions about dosing intervals, which would make the actual administration of these drugs much more complicated and expensive than the use of vancomycin."
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