Initial treatment of dialysis associated peritonitis: a controlled trial of vancomycin versus cefazolin.
OBJECTIVE
To determine if intraperitoneal administration of vancomycin (a slowly absorbed antibiotic) improves the management of dialysis-associated peritonitis over that obtained by using cefazolin, an equally potent, rapidly absorbed antibiotic.


METHODS
A university operated teaching hospital, with patient treatment initiated at home.


METHODS
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.


METHODS
Patients were prospectively allocated into groups adding either vancomycin 25 mgm/L, or cefazolin 50 mgm/L to their dialysate when signs or symptoms of peritonitis developed. Treatment results were analysed using chi-square testing.


RESULTS
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].


CONCLUSIONS
Vancomycin appeared to be superior to cefazolin in the treatment of peritoneal dialysis associated peritonitis.
Flanigan
M J
MJ
Department of Medicine, University of Iowa Hospital and Clinics, Iowa City 52242.
Lim
V S
VS
D000328:Adult; D002437:Cefazolin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010538:Peritonitis / Q000188:drug therapy*; D012008:Recurrence; D014640:Vancomycin / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*
D014640:Vancomycin; D002437:Cefazolin