Efficacy of a non-vancomycin-based peritoneal dialysis peritonitis protocol.
BACKGROUND
Peritonitis has a significant impact upon morbidity and mortality of peritoneal dialysis (PD) patients. Gram-positive organisms account for the majority of infections and vancomycin is a cost effective broad-spectrum antimicrobial treatment for PD peritonitis, but this may lead to the emergence of multiple antibiotic-resistant organisms. The purpose of the present paper was to evaluate the efficacy of a non-vancomycin-based protocol comprising cephazolin and gentamicin, which was introduced in the present PD population as empirical treatment for peritonitis.


METHODS
The study involved 82 peritonitis episodes over a 4-year period in 58 patients, excluding those with previous methicillin-resistant staphylococcal peritonitis.


RESULTS
With cephazolin and gentamicin there was no apparent difference in response or relapse rates in comparison to reported studies using vancomycin-based first-line therapy protocols.


CONCLUSIONS
We advocate initial treatment of PD peritonitis with non-vancomycin-based therapy given similar efficacy and the potential for reduction of resistant organisms.
Toussaint
Nigel
N
Department of Nephrology, St Vincent's Hospital, Melbourne, Victoria, Australia. Nigel.Toussaint@mh.org.au
Mullins
Kim
K
Snider
Jonathon
J
Murphy
Brendan
B
Langham
Robyn
R
Gock
Hilton
H
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002437:Cefazolin / Q000008:administration & dosage*; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D007274:Injections, Intraperitoneal; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D014640:Vancomycin
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D014640:Vancomycin; D002437:Cefazolin