Vancomycin administration in continuous ambulatory peritoneal dialysis: The risk of ototoxicity☆,☆☆,★,★★
Section snippets
METHODS AND MATERIAL
The study covered a one-year period (November 1991 to October 1992) and was carried out in inpatients with end-stage renal disease on CAPD in whom gram-positive peritonitis developed and who were monitored by audiovestibular assessment. Patients in the following categories were excluded from the study: (1) those who were too ill to respond appropriately, (2) those with preexisting sensorineural hearing loss, (3) those with narrow auditory canals, (4) those with a discharging ear or perforated
RESULTS
A total of 16 patients with 22 episodes of peritonitis were included in the study. Twelve of these patients had one episode of peritonitis each, and the other four had recurrent peritonitis. All were subsequently treated with vancomycin. The average age was 50.0 ± 13.5 years (mean ± SD), and the average weight was 56.4 ± 10.65 kg. In all patients the serum creatinine level before the dialysis was above 1000 μmol/L. Data on serum vancomycin and peritoneal fluid levels during the first course of
Evidence of Ototoxicity
The toxic potential of vancomycin is less significant than previously thought. Presently vancomycin is still considered an ototoxic drug, and the likely reason for this belief is based on its initial published reports. 5, 6 This could well be because of the impurities in the early preparations of vancomycin or the concomitant use of vancomycin with aminoglycosides in cases complicated by renal failure. 7 From the literature review of both the clinical and experimental animal studies, the
CONCLUSION
Appropriately administered intraperitoneal vancomycin (30 mg/kg body weight) given 6 days apart in a single course of therapy is both effective and safe. Furthermore, repeated courses of this regimen for recurrent peritonitis in patients receiving CAPD carries no additional risk of ototoxicity. We suggest that to maximize early detection of ototoxic changes, it is essential to incorporate ultra-high frequencies in the monitoring protocol.
Acknowledgements
We thank the staff nurses of the CAPD unit, Miss P. M. Hui and Mr. F. M. Hussain of the audiology unit, and Mr. M. S. Hashim and Miss Safinaz Sabri for technical and clerical assistance. We are indebted to Dr. K. G. Rampal and Dr. Abdullah Sani (Head Department of Otorhinolaryngology) for helpful comments and support. We also thank Dr. Khalid Kadir (Dean) of UKM and the Director General of Health (Dr. Abu Bakar Sulaiman) for permission to publish these data. We also thank Dr. Eugene N. Myers,
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Chapter 8 Rationale and utility of therapeutic drug monitoring for the optimization of antibiotic therapy
2004, Handbook of Analytical SeparationsCitation Excerpt :It is important to note that most reports relating to vancomycin ototoxicity lack baseline auditory testing on the patients studied. In addition, the definition of ototoxicity varies among the different studies [20,28]. There are other adverse-effects associated with vancomycin use.
Miscellaneous antibacterial drugs
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2021, Tuberculosis in Clinical PracticeVancomycin in peritoneal dialysis: Clinical pharmacology considerations in therapy
2020, Peritoneal Dialysis InternationalDrug-induced ototoxicity: Mechanisms, Pharmacogenetics, and protective strategies
2017, Clinical Pharmacology and TherapeuticsElevations of urinary pH may lower vancomycin serum concentration
2015, International Journal of Clinical Pharmacology and Therapeutics
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From the Departments of Otorhinolaryngology (Dr. Gendeh), Pharmacology (Dr. Aziz), and Nephrology (Dr. Kong), National University of Malaysia, Kuala Lumpur; the Department of Nephrology (Dr. Zahir), Hospital Kuala Lumpur; and the Department of Otorhinolaryngology (Dr. Gibb), National University of Singapore.
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Funded by UKM grant no. 75/92.
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Reprint requests: B. S. Gendeh, Department of Otorhinolaryngology–Head and Neck Surgery, Faculty of Medicine, Hospital National University of Malaysia, Jalan Tenteram, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia.
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