title: The recommendations from the International Society for Peritoneal Dialysis for Peritonitis Treatment: a single-center historical comparison.
abstract: The antibiotic treatment currently recommended by the International Society for Peritoneal Dialysis (ISPD) for peritonitis consists of a combination of a first- and a third-generation cephalosporin. The schedule formerly recommended combined a first-generation cephalosporin and an aminoglycoside. No comparison between the treatment schedules has been performed until now. We compared the effectiveness of these two regimens in peritoneal dialysis-related peritonitis at our center. From January 1999 to April 2000, we followed 107 patients in our PD clinic (period 1: 47% men; 32% with diabetes; mean age: 52 +/- 13 years). We followed a similar number of patients from January 2002 to July 2003 (period 2: 109 patients; 54% men; 51% with diabetes; mean age: 56 +/- 18 years). In each period, diagnosis and treatment of peritonitis were based on the recommendations of the ISPD as earlier described. Negative culture rates were similar in period 1 and period 2 (32% vs. 30%). In both study groups, the bacteria that most commonly caused peritonitis were Staphylococcus epidermidis (period 1: 41%; period 2: 39%) and S. aureus (period 1: 27%; period 2: 18%). Gram-positive infections occurred in 59% of patients during period 1 and in 57% during period 2. Gram-negative infections occurred in 16% of patients during period 1 and in 18% during period 2. We observed no significant difference in the peritonitis cure rate from period 1 to period 2 (78% vs. 83%; chi-square: 0.98; p = 0.3), but changes in the primary antibiotic schedule were necessary in 4 patients in period 1 as compared with 1 patient in period 2. The rates of catheter removal were not significantly different during the two periods (period 1: 14%; period 2: 5%; chi-square: 2.5; p = 0.11). Mortality was also not significantly different during the two periods (period 1: 7%; period 2: 5%; chi-square: 0.23; p = 0.62). The two antibiotic schedules were equally effective in the treatment of peritonitis. Cost-effectiveness, impact on residual renal function, and potential development of bacterial resistance must be considered when selecting the antibiotic schedule for peritonitis treatment.
authors.affiliation: Evangelic School of Medicine, Curitiba, Brazil.
authors.forename: Margarete M
authors.initials: MM
authors.lastname: Silva
authors.forename: Roberto
authors.initials: R
authors.lastname: Pecoits-Filho
authors.forename: Carla S
authors.initials: CS
authors.lastname: Rocha
authors.forename: Andréa E M
authors.initials: AE
authors.lastname: Stinghen
authors.forename: Maria A
authors.initials: MA
authors.lastname: Pachaly
authors.forename: Marcelo M
authors.initials: MM
authors.lastname: Nascimento
authors.forename: Rodrigo P
authors.initials: RP
authors.lastname: Campos
authors.forename: Sirlene
authors.initials: S
authors.lastname: Sauthier
authors.forename: Roseana
authors.initials: R
authors.lastname: Fuerbringer
authors.forename: Miguel C
authors.initials: MC
authors.lastname: Riella
mesh_terms: D002442:Ceftazidime / Q000008:administration & dosage; D002512:Cephalothin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005839:Gentamicins; D002442:Ceftazidime; D002512:Cephalothin