To determine if intraperitoneal administration of vancomycin (a slowly absorbed antibiotic) im proves the management of dialysis-associated peritonitis over that obtained by using cefazolin, an equally potent, rapidly absorbed antibiotic.
Setting
A university operated teaching hospital, with patient treatment initiated at home.
Patients
One hundred thirty-one patients trained to perform peritoneal dialysis (CAPD and CCPD) and followed at the University of Iowa Hospitals and Clinics Home Dialysis Treatment Center.
Design
Patients were prospectively allocated into groups adding either vancomycin 25 mgm/L, orcefazolin 50 mgm/L to their dialysate when signs or symptoms of peritonitis developed. Treatment results were analysed using chi-square testing.
Findings
Compared to cefazolin, initial peritonitis therapy with vancomycin improved the peritonitis resolution rate [67% vs 81 %; p=0.008], reduced the incidence of hospital admissions [68% vs 48%; p=0.001], and decreased the risk of superinfection [4% vs 0%; p=0.039].
Conclusion
Vancomycin appeared to be superior to cefazolin in the treatment of peritoneal dialysis associated peritonitis.
GokalR., JakubowskiC., KingJ.Outcome in patients on continuous ambulatory peritoneal dialysis and hemodialysis: 4-year analysis of a prospective multicentre study.Lancet1987; (ii): 1105–1108.
3.
SlingenemeyerA., MionC., BeraudJ.J., OulesR., BrongerB., BalmesM.Peritonitis a frequently leathel complication of intermittant and continuous peritoneal dialysis.Proc Eur Dial Transplant Assoc1981; 18: 212–219.
4.
BlackH.R., FinkelsteinF.O., LeeR.V.The treatment of peritonitis in patients with chronic indwelling catheters.Trans Am Soc Artif Intern Organs1974; 20: 115119.
5.
TenckhoffH.Chronic Peritoneal Dialysis Manual.University of Washington School of MedicineSeattle, Wash., 1974.
6.
BlintA.J.Diagnosis and management of peritonitis in continuous ambulatory peritoneal dialysis. Report of a working party of the british society for antimicrobial chemotherapy.Lancet1987; (1): 845–848.
7.
KeaneW.F., EverettE.D., FineR.N., GolperT.A., VasS.I., PetersonP.K.CAPD related peritonitis management and antibiotic therapy recomendations.Perit Dial Bull1987; 7(2): 55–68.
8.
GolperT.A., HartsteinA.I.Analysis of the causative pathogens in uncomplicated CAPD-associated peritonitis: Duration of therapy, relapses, and prognosis.Am J Kidney Dis1985; 7: 141–145.
9.
VasS.I.“Peritonitis” in Peritoneal Dialysis.NolphK.D., ed. Martinus Nijhoff PublishersBoston, 1985.
10.
FlaniganM.J., FreemanR.M., LimV.S.Cellular Re sponse to Peritonitis Among Peritoneal Dialysis Patients.Am J Kidney Dis1985; 6(6): 420–424.
11.
FlaniganM.J., NghiemD.D., SchulackJ.A., CorryR.J.The use and complications of three peritoneal dialysis catheter designs.ASAIO Trans1987; 33: 33–38.
12.
HarfordA.M., SicaD.A., TartaglioneT., PolkR.E., DaltonH.P., PoynorW.Vancomycin pharmacokinetics in con tinuous ambulatory peritoneal dialysis patients with peritonitis.Nephron1986; 43: 217–222.
13.
BastaniB., FreerK., ReadD.Treatment of gram positive peritonitis with two intraperitoneal doses of vancomycin in continuous ambulatory peritoneal dialysis patients.Nephron1987; 45: 283–285.
14.
JohnsonC.A., ZimmermanS.W., RoggeM.The Pharmacokinetics of Antibiotics Used to Treat Peritoneal Dialysis-Associated Peritonitis.Am J Kidney Dis1984; 4: 3–17.
15.
SchwalbeR.S., StapletonJ.T., GilliganP.H.Emergence of vancomycin resistance in coagulase-negative staphylococci.N Engl J Med1987; 316: 927–931.
16.
BoeschotenE.W., RietraPJGM, KredietR.T., VisserM.J., AriszL.CAPD Peritonitis: A Prospective trial of oral versus intraperitoneal treatment with cephradine.J Antimicrob Chemother1985; 16: 789–797.
17.
GruerL.D., TurneyJ.H., CurleyJ., MichaelJ., AduD.Vancomycin and tobramycin in the treatment of CAPD peritonitis.Nephran1985; 641: 279–282.
18.
RubinJ., RogersW. A., TaylorH.M.Peritonitis during continuous ambulatory peritoneal dialysis.Ann Intern Med1980; 92: 7–13.
19.
KolmosH.J.Antibiotic treatment of infectious peritonitis in chronic peritoneal dialysis.Scand J Infect Dis1985; 17: 219–224.
JohnsonC.A., WellingP.G., ZimmermanS.W.Pharmacokinetics of oral cephradine in continuous ambulatory peritoneal dialysis patients.Nephron1984; 38: 5761.
22.
GerdingD.N., PetersonL.R., LeglerD.C., HallW.H., SchierlE.A.Ascitic fluid cephalosporin concentrations: Influence of protein binding and serum pharmacokinetics.Antimicrab Agents and Chemother1978; 14: 234–239.
23.
ApplebyD.H., JohnJ.F.Effect of peritoneal dialysis solution on the antimicrobial activity of cephalosporins.Nephron1982; 30: 341–344.
24.
TopleyN., AlobaidiH.M.M., DaviesM., ColesG.A., WilliamsJ.D., LloydD.The effect of dialysate on peritoneal phagocyte oxidative metabolism.Kidney Int1988; 34: 404–411.
25.
GokalR., RamosJ.M., FrancisD.M.A.Peritonitis in continuous ambulatory peritoneal dialysis. Laboratory and Clinical Studies.Lancet1982; 1388–1391.
26.
BoyceN.W., WoodC., ThompsonN.M., KerrP., AtkinsR.C.Intraperitoneal (IP) vancomycin therapy for CAPD peritonitis-A prospective, randomized comparison of intermittant vs continuous therapy.Am J Kidney Dis1988; 12: 304–306.
BuggyB.P., SchabergD.R., SwartzR.D.Intraleukocytic sequestration as a cause of persistent staphylococcus au reus peritonitis in continuous ambulatory peritoneal dialysis.Am J Med1984; 76: 1035–1040.
29.
Bennett-JonesD., WassV., MawsonP.A comparison of intraperitoneal and intravenous/oral antibiotic in CAPDpatients.Perit Dial Bull1987; 7: 31–33.
30.
GruerL.D., KiddyK., AduD., MichaelJ.Once-daily antibiotic treatment of CAPD peritonitis.Lancet1984; 1282.
31.
BraunerL., KahlmeterG., LindholmT., SimonsenO.Vancomycin and netilmicin as first line treatment of peritonitis in CAPD patients.J of Antimicrob Chemother1985; 15: 751–758.
32.
GrayH.H., GouldingS., EykynS.J.Intraperitoneal vancomycin and ceftazidime in the treatment of CAPD peritonitis.Clin Nephrol1985; 23(2): 81–84.
33.
EisenbergE.S., LevbitonI., SoeiroR.Fungal peritonitis in patients receiving peritoneal dialysis: Experience with 11 patients and review of the literature.Rev Infect Dis1986; 8: 309–321.
34.
WestT.E., WalsheJ.J., KroICP, AmsterdamD.Staphy lococcal peritonitis in patients on continuous peritoneal dialysis.J Clin Microbiol1986; 23: 809–812.
35.
McCoyGC, HofmanP.A.M., SchrammK., RasmussenR.Cure rates of staphylococcal peritonitis without catheter removal. (Abstract) Kidney Int1983; 25(1): 259.
36.
KimD., TapsonJ., WuG., KhannaR., VasS.I., OreopoulosD.G.Staph aureus peritonitis in patients on continuous ambulatory peritoneal dialysis.Trans Am Soc Artif Intern Organ1984; 30: 494–497.
37.
GrefbergN.S., DanielsonB.G., NilssonP.Peritonitis in patients on continuous ambulatory peritoneal dialysis. A changing scene.Scand J lnfect Dis1984; 16: 187193.
38.
NorrisK.C., ShinabergerJ.H., ReyesG.D., KrautA.The use of intracatheter instillation of streptokinase in the treatment of recurrent bacterial peritonitis in continuous ambulatory peritoneal dialysis.Am J Kidney Dis1987; 10: 62–65.
39.
DratwaM., GlupczynskiY., LameireN.Aztre onam in CAPD peritonitis.Lancet1987; 213–214.
