title: Oral treatment of CAPD-peritonitis with ciprofloxacin.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: E W
authors.initials: EW
authors.lastname: Boeschoten
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuijper
authors.forename: P
authors.initials: P
authors.lastname: Speelman
authors.forename: D G
authors.initials: DG
authors.lastname: Struijk
authors.forename: R T
authors.initials: RT
authors.lastname: Krediet
authors.forename: L
authors.initials: L
authors.lastname: Arisz
mesh_terms: 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*
chemical_list: D002939:Ciprofloxacin