A randomized prospective comparison of oral levofloxacin plus intraperitoneal (IP) vancomycin and IP netromycin plus IP vancomycin as primary treatment of peritonitis complicating CAPD.
OBJECTIVE
To compare the therapeutic efficacy of daily oral levofloxacin plus intermittent intraperitoneal (IP) vancomycin (group 1) versus daily IP netromycin and intermittent IP vancomycin (group 2) in the primary treatment of peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD).


METHODS
A randomized multicenter prospective open-label comparative clinical study.


METHODS
University and Hospital Authority hospitals in Hong Kong.


METHODS
All CAPD patients who developed bacterial or culture-negative peritonitis beyond 28 days of a previous episode and without evidence of septicemia, associated tunnel infection, or known sensitivity to trial medications were accepted into the clinical trial.


RESULTS
A total of 101 patients entered the trial. The primary cure rate was 74.5% for group 1 and 73.6% for group 2. Baseline culture results appeared to influence the clinical outcome: the primary cure rate for culture-negative, gram-positive, and gram-negative episodes was 83.3%, 78.6%, and 42.9% for group 1 and 69.1%, 76.9%, and 71.3% for group 2, respectively. The primary cure rate also varied considerably among individual centers and was particularly noticeable in group 1. In the latter group, it correlated closely with in vitro levofloxacin resistance which in turn correlated closely with previous exposure to fluoroquinolones.


CONCLUSIONS
Oral levofloxacin in combination with intermittent IP vancomycin has comparable efficacy to IP netromycin combined with intermittent IP vancomycin as primary treatment in CAPD peritonitis, but is simpler and more cost-effective to administer. It may be recommended as primary therapy in centers with relatively low exposure and, therefore, low background resistance to fluoroquinolones.
Cheng
I K
IK
Department of Medicine, Queen Mary Hospital, Hong Kong.
Fang
G X
GX
Chau
P Y
PY
Chan
T M
TM
Tong
K L
KL
Wong
A K
AK
Li
C S
CS
Lo
W K
WK
Cheung
K O
KO
Kumana
C R
CR
D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004352:Drug Resistance, Microbial; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy; D006801:Humans; D007274:Injections, Intraperitoneal; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D009428:Netilmicin / Q000008:administration & dosage / Q000627:therapeutic use*; D015242:Ofloxacin / Q000008:administration & dosage / Q000627:therapeutic use*; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy* / Q000382:microbiology; D011446:Prospective Studies; D012074:Remission Induction; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D005839:Gentamicins; D009428:Netilmicin; D064704:Levofloxacin; D014640:Vancomycin; D015242:Ofloxacin