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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44; </span></p><p class="elsevierStylePara">Peritonitis is one of the main causes of morbidity in patients undergoing peritoneal dialysis &#40;PD&#41;&#46; Although the usual treatments with vancomycin&#44; aminoglycosides or semi-synthetic penicillins recommended in treatment guidelines for peritonitis<span class="elsevierStyleSup">1</span> are efficient in most cases&#44; situations such as colonisation by methicillin-resistant microorganisms with some degree of resistance to vancomycin are common&#46; These treatments are ineffective in these cases&#46;</p><p class="elsevierStylePara">The proliferation of multi-resistant gram-positive pathogens has led to the antibiotic daptomycin being brought back and its clinical development has started again&#46; It was approved by the United States Food and Drug Administration &#40;FDA&#41; in 2003 for the treatment of endocarditis caused by gram-positive pathogens&#44; and skin and white-tissue infections&#46;</p><p class="elsevierStylePara">A case study has been published of peritonitis which was not linked to the peritoneal catheter that was treated with intravenous daptomycin&#46; This study analysed the concentration of daptomycin reached in the peritoneal fluid after intravenous administration&#46; It was found to be 5mg&#47;ml &#40;minimum inhibitory concentration &#91;MIC&#93;&#61;4mg&#47;ml&#41;&#46;<span class="elsevierStyleSup">2</span> Therefore&#44; the concentrations in the intraperitoneal fluid as a result of intraperitoneal administration of the antibiotic would be less close to the microorganism MIC for daptomycin&#46;</p><p class="elsevierStylePara">The clinical experience published to date is limited to two cases&#46; Intraperitoneal daptomycin was used in these cases to treat peritonitis caused by vancomycin-resistant gram-positive bacteria&#46;<span class="elsevierStyleSup">3</span> This treatment succeeded in these cases where conventional therapies had previously failed&#46; The intraperitoneal administration of daptomycin was well tolerated in these patients and they had no peritoneal irritation or negative effects associated with the administration of drugs through this route&#46;</p><p class="elsevierStylePara">Furthermore&#44; daptomycin is a drug that is currently used to treat catheter-related bacteriaemias<span class="elsevierStyleSup">4</span> due to its efficacy in controlling biofilm growth&#44; and that is why it may be considered useful in the treatment of biofilm on intraperitoneal catheters&#46;</p><p class="elsevierStylePara">We report here the clinical case of a 61-year-old man who had been diagnosed with advanced chronic kidney disease &#40;CKD&#41; secondary to diabetic nephropathy since 2001&#46; He started PD in December 2006&#46; The patient has had three episodes of peritonitis since February 2008 that led us to consider removing the catheter in October 2009 due to suspected biofilm&#46;</p><p class="elsevierStylePara">In May 2010 he had a new episode of peritonitis and was started on intraperitoneal empiric treatment with vancomycin following normal dosage guidelines &#40;a shock dosage of 2g followed by 2g&#47;3 days and a shock dosage of 100mg of tobramycin and 50mg&#47;24h&#41;&#46; The presence of <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> and <span class="elsevierStyleItalic">Streptococcus viridans </span>which were only sensitive to carbapenems<span class="elsevierStyleItalic"> </span>was found four days later when the culture results were received&#46; We&#44; therefore&#44; continued with the intraperitoneal treatment with vancomycin at a dose of 2g a week &#40;3 weeks&#41;&#44; and tobramycin was changed for 1g of imipenem&#47;24h for 14 days&#46;</p><p class="elsevierStylePara">He had a new relapse in June 2010 and <span class="elsevierStyleItalic">S&#46; epidermidis </span>with intermediate sensitivity to vancomycin &#40;MIC&#61;2&#41; was isolated&#46; Treatment with vancomycin was started according to protocol&#44; with a positive clinical response&#44; although after this relapse&#44; it was suspected that the peritoneal catheter had been colonised by <span class="elsevierStyleItalic">S&#46; epidermidis </span>biofilm&#46; An application was made for the compassionate use of intraperitoneal daptomycin on the basis of the previous experience of two clinical cases published&#46; Treatment with vancomycin was maintained until daptomycin was authorised&#46;</p><p class="elsevierStylePara">We used the following treatment plan with daptomycin&#58;</p><p class="elsevierStylePara">A shock dosage of 200mg &#40;in a 2l PD1 solution&#41;&#44; followed by 40mg in each change of the intraperitoneal fluid &#40;four times a day&#41; for 10 days&#46; After finishing this treatment plan&#44; the catheter was then put in an antibiotic lock with 350mg in 7ml for 12h once a week for one month&#46; The patient responded positively to this treatment and has had no relapses or new episodes of peritonitis&#46;</p>"
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Intraperitoneal daptomycin
Administración intraperitoneal de daptomicina
L.. García-Lópeza, L.. Gómez Sayagoa, M.J.. Fernández-Reyes Luisb
a Servicio de Farmacia, Hospital General de Segovia,
b Servicio de Nefrología, Hospital General de Segovia,
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44; </span></p><p class="elsevierStylePara">Peritonitis is one of the main causes of morbidity in patients undergoing peritoneal dialysis &#40;PD&#41;&#46; Although the usual treatments with vancomycin&#44; aminoglycosides or semi-synthetic penicillins recommended in treatment guidelines for peritonitis<span class="elsevierStyleSup">1</span> are efficient in most cases&#44; situations such as colonisation by methicillin-resistant microorganisms with some degree of resistance to vancomycin are common&#46; These treatments are ineffective in these cases&#46;</p><p class="elsevierStylePara">The proliferation of multi-resistant gram-positive pathogens has led to the antibiotic daptomycin being brought back and its clinical development has started again&#46; It was approved by the United States Food and Drug Administration &#40;FDA&#41; in 2003 for the treatment of endocarditis caused by gram-positive pathogens&#44; and skin and white-tissue infections&#46;</p><p class="elsevierStylePara">A case study has been published of peritonitis which was not linked to the peritoneal catheter that was treated with intravenous daptomycin&#46; This study analysed the concentration of daptomycin reached in the peritoneal fluid after intravenous administration&#46; It was found to be 5mg&#47;ml &#40;minimum inhibitory concentration &#91;MIC&#93;&#61;4mg&#47;ml&#41;&#46;<span class="elsevierStyleSup">2</span> Therefore&#44; the concentrations in the intraperitoneal fluid as a result of intraperitoneal administration of the antibiotic would be less close to the microorganism MIC for daptomycin&#46;</p><p class="elsevierStylePara">The clinical experience published to date is limited to two cases&#46; Intraperitoneal daptomycin was used in these cases to treat peritonitis caused by vancomycin-resistant gram-positive bacteria&#46;<span class="elsevierStyleSup">3</span> This treatment succeeded in these cases where conventional therapies had previously failed&#46; The intraperitoneal administration of daptomycin was well tolerated in these patients and they had no peritoneal irritation or negative effects associated with the administration of drugs through this route&#46;</p><p class="elsevierStylePara">Furthermore&#44; daptomycin is a drug that is currently used to treat catheter-related bacteriaemias<span class="elsevierStyleSup">4</span> due to its efficacy in controlling biofilm growth&#44; and that is why it may be considered useful in the treatment of biofilm on intraperitoneal catheters&#46;</p><p class="elsevierStylePara">We report here the clinical case of a 61-year-old man who had been diagnosed with advanced chronic kidney disease &#40;CKD&#41; secondary to diabetic nephropathy since 2001&#46; He started PD in December 2006&#46; The patient has had three episodes of peritonitis since February 2008 that led us to consider removing the catheter in October 2009 due to suspected biofilm&#46;</p><p class="elsevierStylePara">In May 2010 he had a new episode of peritonitis and was started on intraperitoneal empiric treatment with vancomycin following normal dosage guidelines &#40;a shock dosage of 2g followed by 2g&#47;3 days and a shock dosage of 100mg of tobramycin and 50mg&#47;24h&#41;&#46; The presence of <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> and <span class="elsevierStyleItalic">Streptococcus viridans </span>which were only sensitive to carbapenems<span class="elsevierStyleItalic"> </span>was found four days later when the culture results were received&#46; We&#44; therefore&#44; continued with the intraperitoneal treatment with vancomycin at a dose of 2g a week &#40;3 weeks&#41;&#44; and tobramycin was changed for 1g of imipenem&#47;24h for 14 days&#46;</p><p class="elsevierStylePara">He had a new relapse in June 2010 and <span class="elsevierStyleItalic">S&#46; epidermidis </span>with intermediate sensitivity to vancomycin &#40;MIC&#61;2&#41; was isolated&#46; Treatment with vancomycin was started according to protocol&#44; with a positive clinical response&#44; although after this relapse&#44; it was suspected that the peritoneal catheter had been colonised by <span class="elsevierStyleItalic">S&#46; epidermidis </span>biofilm&#46; An application was made for the compassionate use of intraperitoneal daptomycin on the basis of the previous experience of two clinical cases published&#46; Treatment with vancomycin was maintained until daptomycin was authorised&#46;</p><p class="elsevierStylePara">We used the following treatment plan with daptomycin&#58;</p><p class="elsevierStylePara">A shock dosage of 200mg &#40;in a 2l PD1 solution&#41;&#44; followed by 40mg in each change of the intraperitoneal fluid &#40;four times a day&#41; for 10 days&#46; After finishing this treatment plan&#44; the catheter was then put in an antibiotic lock with 350mg in 7ml for 12h once a week for one month&#46; The patient responded positively to this treatment and has had no relapses or new episodes of peritonitis&#46;</p>"
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Article information
ISSN: 20132514
Original language: English
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