Fluoroquinolones may be a good alternative for the treatment of bacterial peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). To test their efficiency against Gram-positive bacteria, we treatedwith intraperitoneal (i.p.) ciprofloxac in 30 episodes of Gram-positive bacterial peritonitis without manifest tunnel infection of the peritoneal catheters. Treatment was sustained for 5 days, then orally for 10 further days. Clinical and bacteriological responses were satisfactory in 25 cases, but resolution of infection was slow in 5 cases of Staphylococcus aureus. The minimal inhibitory and bactericidal concentrations were 0.06250.50 and 0.125-1.0 μg/mL respectively, lower than the plasma and dialysate concentrations of the drug. Side effects were negligible. We conclude that ciprofloxacin provides a good therapeutic alternative to more widely used antibiotics for the empirical treatment of peritonitis in patients undergoing CAPD. However, combinations of antibiotics may be necessary, in Staphylococcus aureus peritonitis.
HooperD.C., Wolf sonJ.S.Mode of action of the quinolone antimicrobial agents.Rev Infect Dis1988; 10(Suppl 1): S14–21.
9.
WebsterA., GayaH.Quinolones in the treatment of serious infections.Rev Infect Dis1988; 10(Suppl 1): S22533.
10.
ShalitI., GreenwoodR.B., MarksM.I., PedersonJ.A.Pharmacokinetics of single dose oral ciprofloxacin in patients undergoing CAPD.Antimicrob Agents Chemother1986; 30: 152–6.
11.
FlemingL.W., MorelandT.A., ScottA.C., StewartW.K., WhiteL.O.Ciprofloxacin in plasma and peritoneal dialysate after oral therapy in patients on CAPD.J Antimicrob Chemother1987; 19: 493–503.
BenzacourM., LagardeC., BeneventD., MounierM., DensF.Peritonitis during CAPD. Treatment with pefloxacin: First results and pharmacokinetics.Nephron1988; 50: 175–6.
14.
GuayD., KlickerR., PenceT., PetersonP.In vitro anti staphylococcal activity of teicoplanin and ciprofloxacin in peritoneal dialysis effluent.Eur J Clin Microbiol1986; 5: 661–3.
15.
DrusanoG.L., WeirM., ForrestA., PlaisanceK., EmmT., StandifordH.C.Pharmacokinetics ofi. v. administered ciprofloxacin in patients with various degrees of renal function.Antimicrob Agents Chemother1987; 31: 8604.
16.
McCormickE.M., EcholsR.M.Effect of peritoneal dialysis fluid and pH on bactericidal activity of ciprofloxacin.Antimicrob Agents Chemother1987; 31: 657–9.
17.
ScottA.C., FlemingL.W., StewartW.K.Efficacy of ciprofloxacin in treatment of CAPD peritonitis.Eur J Clin Microbiol1987; 6: 599.
18.
GolperT.A., HarsteinAl, MorthlandV.H., ChristensenJ.M.Effects of antacids and dialysate dwell times on multiple-dose pharmacokinetics of oral ciprofloxacin in patients on CAPD.Antimicrob Agents Chemother1987; 31: 1787–90.
19.
Weissauer-CondonC., EngelsI., DaschnerE.D.In vitro activity of four new quinolones in Mueller-Hinton Broth and peritoneal dialysis fluid.Eur J Clin Microbiol1987; 6: 324–6.
20.
ChanM.K., Chaupy, ChanW.W.N.Ofloxacin pharmacokinetics in patients on CAPD.Clin Nephrol1987; 28: 277–80.
21.
NeuH.C.Ciprofloxacin: An overview and prospective appraisal.Am J Med1987; 82(Suppl 4A): 395–404.
22.
VenezioF.R., TatarowiczW., diVicenzoC.A., O'KeefeJ.P.Activity of ciprofloxacin against multiply resistant strains of P. aeruginosa, S. epidermidis and Group JK Corynebacteria.Antimicrob Agents Chemother1986; 30: 940–1.
23.
van der AuweraP., KlasterskyJ.Bactericidal activity and killing rate of serum in volunteers receiving ciprofloxacin alone or in combination with vancomycin.Antimicrob Agents Chemother1986; 30: 892–5.
24.
AldridgeK.E., SandersC.V.Comparative in vitro activity of ciprofloxacin, norfloxacin, ofloxacin, beta-Iactam antibiotics and gentamicin against aerobic grampositive cocci and gram-negative bacilli.Rev Infec Dis1988; 10(Suppl 1): S42.
25.
NeuH.C.Bacterial resistance to fluoroquinolones.Rev Infect Dis1988; 10(Suppl 1): S57–63.
26.
SimberkoffM.S., RahalJ.J.Bactericidal activity of ciprofloxacin against amikacin-cefotaxime-resistant gram-negative bacilli and methicillin-resistant staphylococci.Antimicrob Agents Chemother1986; 29: 1098–100.
27.
KaatzG.W., BarriereS.L., SchabergD.S., FeketyR.Ciprofloxacin versus vancomycin in the therapy of experimental methicillin-resistant S. aureus endocarditis.Antimicrob Agents Chemother1987; 31: 527–30.
28.
Gahrn-HansenB., SogarrdP., ArpiM.In vitro activity of ciprofloxacin against methicillin-susceptible and methicillin-resistant staphylococci.Eur J Clin Microbiol1987; 6: 581–4.
29.
WeberA., ChaffinD., SmithA., OpheimK.E.Quantitation of ciprofloxacin in body fluids by high-pressure liquid chromatography.Antimicrob Agents Chemother1985; 27: 531–4.
30.
EricssonH.M., SherrisJ.C.Antibiotic sensitivity testing report of an international collaborative study.Acta Pathol Microbiol Scand (B)(Suppl)1971; 217: 190.
31.
PancorboS., ComtyC.Peritoneal transport of vancomycin in 4 patients undergoing CAPD.Nephron1982; 31: 37–9.
32.
KrothapalliR.K., SenekjianH.O., AyusJ.C.Efficacy of intravenous vancomycin in the treatment of grampositive peritonitis in long-term peritoneal dialysis.Am J Med1983; 75: 345–8.
33.
BastaniB., FreerK., ReadD.Treatment of grampositive peritonitis with two intraperitoneal doses of vancomycin in CAPD patients.Nephron1987; 45: 2835.
34.
SchwalbeR.S., StapletonJ.T., GilliganP.H.Emergence of vancomycin resistance in coagulase-negative staphylococci.N Engl J Med1987; 316: 927–31.
35.
EliopoulosG.M.New quinolones. Pharmacology, pharmacokinetics and dosing in patients with renal insufficiency.Rev Infect Dis1988; 10(Suppl 1): 102–9.
36.
ShalitI., BergerS.A., GoreaA., FrimermanH.Widespread quinolone resistance among methicillin-resistant S. aureus isolates in a general hospital.Antimicrob Agents Chemother1989; 33: 593–4.
37.
ZimmermanS.W., O'BrienM., WiedenhoeftA., JohnsonC.A.S. aureus peritoneal catheter-related infections: A cause of catheter loss and peritonitis.Perit Dial Int1988; 8: 191–4.
