Two patients on CAPD developed peritonitis refractory to antibiotics appropriate to the cultured organisms. In one case, cultures remained positive for the offending bacteria (Staphylococcus aureus) and, in the other, cultures of Enterobacter agglomerans rapidly became negative but signs and symptoms of peritonitis persisted. Empiric clindamycin therapy was associated with rapid resolution of peritonitis in both instances without necessitating catheter removal. We suggest that, in selected cases of refractory peritonitis, the addition of clindamycin may lead to clearing of the infection with preservation of the peritoneal catheter.
VasS.I.What are the indications for removal of the permanent peritoneal catheterPerit Dial Bull1981; 1: 145–146.
2.
ProwantB., NolphK.D.Five years’ experience with peritonitis in a CAPD program.Perit Dial Bull1982; 2: 169–173.
3.
HandW.L., King ThompsonN.L.Membrane transport of clindamycin in alveolar macrophages.Anti microb Agents Chemother1982; 21: 241–247.
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SchwabS., HinthornD., DiederichD.pH-dependent accumulation of clindamycin in a polycystic kidney.Amer J Kid Dis1983; 3: 63–66.
5.
Pharmaceutical Society of Great Britain: British Pharmaceutical Codex 1973.London, The Pharmaceutical Press1973: 983.
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VerbrughH.A., KeaneJ.R., HoidalM.R.Peritoneal macrophages and opsonins: Antibacterial defense in patients undergoing chronic peritoneal dialysis.J Infect Dis1973; 147: 1018–1029.
7.
VasS.I., DuweA., WeatherheadJ.Natural defense mechanisms of the peritoneum: The effect of peritoneal dialysis fluid on polymorphonuclear cells. In: AtkinsK.. eds. Peritoneal dialysis.Edinburgh: Churchill Livingston1981; 41–51.
8.
DuweA.K., VasS.I., WeatherheadJ.W.Effect of composition of peritonal dialysis fluid on chemiluminescence, phagocytosis, and bactericidal activity in vitro.Infect Immune1981; 33: 130–135.
9.
OreopoulosD.G.Recommendations for future research in continuous ambulatory peritoneal dialysis.Perit Dial Bull1982; 2: 149–150.
10.
VasS.I.Microbiologic aspects of chronic ambulatory peritoneal dialysis.Kidney Intern1983; 23: 83–92.
11.
The Pharmacological Basis of Therapeutics.GilmanA.G.. eds. New York: MacMillan1980; 1226.
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TedescoP.J.Clindamycin and colitis; a review.J Infect Dis1977; 1355: 95–98.
13.
OreopoulosD.G., WilliamsP., KhannaR.Treatment of Peritonitis.Perit Dial Bull1981; 1: 517.
