Prophylaxis against fungal peritonitis in CAPD--a single center experience with low-dose fluconazole.
OBJECTIVE
Fungal peritonitis (FP) significantly alters the outcome of patients on peritoneal dialysis (PD). Exposure to antibiotics is a risk factor for subsequent FP. Antifungal prophylaxis has been tried, with varying success, to prevent the occurrence of antibiotic-related fungal peritonitis (AR-FP). We aimed to evaluate the effect of prophylaxis with a low dose of fluconazole, in preventing AR-FP.


METHODS
In this retrospective review, we examined the incidence of FP in a cohort of 115 patients, who had received antibiotics for bacterial peritonitis and received a co-prescription of fluconazole, 50 mg/day for the duration of antibiotic therapy. The incidence of bacterial peritonitis and FP for up to 3 months after antibiotic therapy was noted.


RESULTS
One hundred and fifteen patients were followed up over a 6-year period, for 2549 patient-months. We observed 82 episodes of bacterial peritonitis and a total of 137 antibiotic prescriptions. The peritonitis rate was 1 episode per 31.08 patient-months (1 per 2.58 patient-year, 0.38 episodes every patient-year). We had six episodes of FP. There were no episodes of AR-FP.


CONCLUSIONS
We observed very low rates of both bacterial peritonitis and FP, and prophylaxis with low-dose fluconazole seemed to confer protection against AR-FP. We did not encounter any adverse effects with its use.
Prabhu
Mayoor V
MV
Department of Nephrology, Global Hospitals, Lakdi-ka-pool, Hyderabad, India. drprabhunephro@gmail.com
Subhramanyam
Sreepada V
SV
Gandhe
Sridhar
S
Antony
Sinoj K
SK
Nayak
K Shivanand
KS
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage*; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000517:prevention & control*; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010538:Peritonitis / Q000382:microbiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D055815:Young Adult
D000935:Antifungal Agents; D015725:Fluconazole