Treatment of peritoneal dialysis-associated peritonitis with continuous versus intermittent vancomycin/teicoplanin and ceftazidime in children: preliminary results of a prospective randomized trial. Members of APN Arbeitsgemeinschaft Paidiatrische Nephrologie.
A recent treatment update for continuous peritoneal dialysis (CPD)-associated peritonitis recommends first-line use of continuously or intermittently administered intraperitoneal vancomycin and ceftazidine. Teicoplanin has recently been introduced as a potentially less toxic alternative glycopeptide antibiotic. However, efficacy and safety have not been demonstrated for intermittent treatment schedules or for the use of teicoplanin in prospective studies. Therefore, a prospective trial on the treatment of CPD-associated peritonitis was started in 15 pediatric dialysis units using vancomycin or teicoplanin, in combination with ceftazidine. Vancomycin or teicoplanin was administered either continuously with each bag of dialysate for 10 days or as a single dose on days 1 and 8, and ceftazidime either continuously or in one bag of dialysate per day. Until December 31, 1994, 81 episodes of peritonitis including 16 relapses occurred in a cohort of 120 patients. The incidence of peritonitis was 1 episode/13.7 months, regardless of treatment modality [continuous ambulatory peritoneal dialysis (CAPD) or continuous cycling peritoneal dialysis (CCPD)]. Thirty-six (57%) primary peritonitis episodes were caused by staphylococci (21 Staphylococcus aureus, 15 coagulase-negative), 12 (19%) by gram-negative bacteria, 7 by other germs, and in 8 (13%) cases cultures remained sterile. Primary treatment response was achieved in 43/46 (93%) gram-positive and 4/12 (33%) gram-negative peritonitis episodes. Relapses occurred only with gram-positive bacteria (16/63, 25%). In cases of gram-positive peritonitis, no differences in primary response (25/25 vs 15/18) or relapse rates (10/36 vs 6/27) were observed between groups on continuous and intermittent treatment, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Klaus
G
G
Department of Pediatrics, University of Heidelberg, Germany.
Schaefer
F
F
Müller-Wiefel
D
D
Mehls
O
O
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology; D002442:Ceftazidime / Q000008:administration & dosage; D002511:Cephalosporins / Q000008:administration & dosage; D002648:Child; D004359:Drug Therapy, Combination / Q000008:administration & dosage*; D006801:Humans; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects; D010538:Peritonitis / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D012008:Recurrence; D017334:Teicoplanin / Q000008:administration & dosage; D014640:Vancomycin / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D017334:Teicoplanin; D014640:Vancomycin; D002442:Ceftazidime