Pharmacokinetics and pharmacodynamics of antistaphylococcal antibiotics in continuous ambulatory peritoneal dialysis patients.

Staphylococci are the leading pathogens in continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis. Vancomycin appears to be an outstanding antistaphylococcal drug because resistance to it is nearly absent. The pharmacokinetics of vancomycin and clinical cure rates of peritonitis with different dosing guidelines have been studied extensively. Different dosing guidelines with IP or IV loading doses followed or not followed by IP maintenance doses are used successfully, despite the fact that some of the dosing schemes produce apparently suboptimal drug levels referring to in vitro data like the MIC value (minimum inhibitory concentration). Alternatively, aminoglycosides, cephalosporins, isoxazolyl penicillins, and broad-spectrum penicillins combined with beta-lactamase inhibitors may be used for the treatment of gram-positive peritonitis. For the above penicillins pharmacokinetic data are scarce, and clinical experience is limited. Rifampin has excellent intracellular antistaphylococcal activity and should be used in combination with other antibiotics. Although pharmacokinetic data are lacking, rifampin dosages do not require adaptation to renal function or replacement therapy.