Oral treatment of CAPD-peritonitis with ciprofloxacin.
Peritonitis is still a major problem in CAPD. The synthetic chemotherapeutic quinolone ciprofloxacin offers new possibilities for oral treatment of this complication. The efficacy of ciprofloxacin as first-line antibiotic was investigated in five consecutive peritonitis episodes of five patients. The dosage was deduced from a pilot study and consisted of an intra-peritoneal loading dose during the first 24 hours. Simultaneously ciprofloxacin was given orally and thereafter only the oral medication was continued. The causative microorganisms in the 5 episodes were (MIC90 in brackets): nonfermentative Gram negative rod, group IVc-2 (0.6 micrograms/ml), S. aureus (0.25 micrograms ml), Strep. faecalis (0.4 micrograms/ml), S. aureus + S. epidermidis (both 0.25 micrograms/ml) and S. aureus (0.13 micrograms/ml). The clinical course was uncomplicated and all episodes were cured with ciprofloxacin monotherapy. In 4 patients all dialysate concentrations exceeded 2.3 micrograms/ml (mean 5.8 micrograms/ml). In one patient dialysate concentrations varied between 2.2 and 7.5 micrograms/ml during the first 24 hrs and between 0.4 and 1.2 micrograms/ml thereafter. Despite these low dialysate concentrations, the episode caused by S. aureus (MIC90 0.25 micrograms/ml) was cured uneventfully. We conclude that ciprofloxacin may be useful for the treatment of CAPD peritonitis. Large interindividual differences in dialysate concentrations should be taken into account.
Boeschoten
E W
EW
Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Kuijper
E J
EJ
Speelman
P
P
Struijk
D G
DG
Krediet
R T
RT
Arisz
L
L
D000284:Administration, Oral; D002939:Ciprofloxacin / Q000008:administration & dosage* / Q000627:therapeutic use; D004341:Drug Evaluation; D006801:Humans; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy*; D013203:Staphylococcal Infections / Q000188:drug therapy*
D002939:Ciprofloxacin