title: Does antifungal prophylaxis with daily oral fluconazole reduce the risk of fungal peritonitis in peritoneal dialysis patients? The Pan Thames Renal Audit.
abstract: OBJECTIVE
  Fungal peritonitis increases the risk of transfer to haemodialysis and mortality.
  
  
  METHODS
  We audited the effect of co-prescription of daily oral fluconazole with antibiotics in the Pan Thames centres on fungal peritonitis.
  
  
  RESULTS
  We found 49 (1.5%) fungal peritonitis cases in 3,322 episodes of peritonitis. Two centres co-prescribed prophylactic fluconazole with antibiotics, with a fungal peritonitis rate of 0.0032/patient year, compared to 0.0099 from centres not using prophylaxis. However, centres using fungal prophylaxis had lower peritonitis rates of 0.036, compared to 0.05 for the other centres. Correcting for background peritonitis rates, there was no significant difference in the incidence of fungal peritonitis.
  
  
  CONCLUSIONS
  In centres with a low incidence of fungal peritonitis, additional co-prescription of fluconazole with antibiotics appeared to reduce the risk of fungal peritonitis. However, variation in practice between centres is the main determinant of the observed incidence of fungal peritonitis rather than the use of antifungal prophylaxis.
authors.affiliation: UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, Royal Free Campus, London, UK. andrewdavenport@nhs.net
authors.forename: Andrew
authors.initials: A
authors.lastname: Davenport
authors.forename: David
authors.initials: D
authors.lastname: Wellsted
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage*; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D010530:Peritoneal Dialysis; D010538:Peritonitis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole