Treatment and outcome of peritonitis in automated peritoneal dialysis, using a once-daily cefazolin-based regimen.
OBJECTIVE
We determined the effectiveness of a once-daily cefazolin-based regimen in treating automated peritoneal dialysis (APD) peritonitis.


METHODS
We carried out a retrospective analysis of all APD peritonitis episodes treated with a once-daily cefazolin protocol.


METHODS
The study was performed in a peritoneal dialysis unit in a tertiary care hospital.


METHODS
We studied 60 episodes of primary peritonitis in 40 patients on APD. Each patient was treated with a vancomycin-free regimen consisting of intraperitoneal cefazolin (1.5 g IP) with gentamicin IP administered in the daytime exchange. The main outcome measures were successful treatment of peritonitis, removal of peritoneal catheter, relapse of peritonitis, and patient death.


RESULTS
Gram-positive infections occurred in 35 episodes (58.3%), gram-negative Infections in 10 episodes (16.7%), culture-negative infections in 14 episodes (23.3%), and a yeast infection in 1 episode (1.7%). Of the 60 episodes, 47 (78.3%) were successfully treated. In 10 episodes (16.7%), catheters were removed (9 for treatment failure, 1 for yeast infection). Four patients (8%) had a relapse of infection within 4 weeks of completing antibiotic therapy. One patient (1.7%) died.


CONCLUSIONS
Our results demonstrate that once-daily cefazolin with gentamicin IP is an effective treatment for APD peritonitis, with the advantage of being easy to administer and enabling patients to remain on APD during treatment.
Fielding
Richard E
RE
Department of Renal Medicine, Imperial College School of Medicine, Charing Cross Hospital, London, UK. RFielding@hhnt.org
Clemenger
Michelle
M
Goldberg
Lawrence
L
Brown
Edwina A
EA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D002437:Cefazolin / Q000008:administration & dosage* / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy* / Q000209:etiology*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D002437:Cefazolin