title: Intraperitoneal Vancomycin Plus Either Oral Moxifloxacin or Intraperitoneal Ceftazidime for the Treatment of Peritoneal Dialysis-Related Peritonitis: A Randomized Controlled Pilot Study.
abstract: BACKGROUND
  Intraperitoneal administration of antibiotics is recommended as a first treatment for managing peritoneal dialysis (PD)-related peritonitis. However, the efficacy of oral administration of quinolones has not been well studied.
  
  
  METHODS
  Randomized controlled pilot study.
  
  
  METHODS
  80 eligible patients with PD-related peritonitis from Peking University First Hospital (40 in each arm).
  
  
  METHODS
  Intraperitoneal vancomycin, 1g, every 5 days plus oral moxifloxacin, 400mg, every day (treatment group) versus intraperitoneal vancomycin, 1g, every 5 days plus intraperitoneal ceftazidime, 1g, every day (control group).
  
  
  RESULTS
  The primary end point was complete resolution of peritonitis, and secondary end points were primary or secondary treatment failure.
  
  
  METHODS
  PD effluent white blood cell count.
  
  
  RESULTS
  Baseline demographic and clinical characteristics of the 2 groups were comparable. There were 24 and 22 Gram-positive organisms, 6 and 7 Gram-negative organisms, 9 and 10 culture-negative samples, and 1 and 1 fungal sample in the treatment and control groups, respectively. Complete resolution of peritonitis was achieved in 78% and 80% of cases in the treatment and control groups, respectively (OR, 0.86; 95% CI, 0.30-2.52; P=0.8). There were 3 and 1 cases of relapse in the treatment and control groups, respectively. Primary and secondary treatment failure rates were not significantly different (33% vs 20% and 10% vs 13%, respectively). In each group, there was 1 peritonitis-related death and 6 transfers to hemodialysis therapy. During the 3-month follow-up period, 7 and 3 successive episodes of peritonitis occurred in the treatment and control groups, respectively. Only 2 adverse drug reactions (mild nausea and mild rash, respectively) were observed in the 2 groups.
  
  
  CONCLUSIONS
  Sample size was relatively small and the eligibility ratio was low. Also, the number of peritonitis episodes was low, limiting the power to detect a difference between groups.
  
  
  CONCLUSIONS
  This pilot study suggests that intraperitoneal vancomycin with oral moxifloxacin is a safe, well-tolerated, practical, and effective first-line treatment for PD-related peritonitis. Larger adequately powered clinical trials are warranted.
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Beijing, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Xu
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Beijing, China.
authors.forename: Zhikai
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Beijing, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Qu
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Beijing, China.
authors.forename: Huan
authors.initials: H
authors.lastname: Wang
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Beijing, China.
authors.forename: Xue
authors.initials: X
authors.lastname: Tian
authors.affiliation: Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Beijing, China. Electronic address: dongjie@medmail.com.cn.
authors.forename: Jie
authors.initials: J
authors.lastname: Dong
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002442:Ceftazidime / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010537:Peritoneum; D010538:Peritonitis / Q000188:drug therapy* / Q000209:etiology*; D010865:Pilot Projects; D011446:Prospective Studies; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D014640:Vancomycin; D002442:Ceftazidime; D000077266:Moxifloxacin
keywords: Intraperitoneal vancomycin; PD-related peritonitis; complete cure; continuous ambulatory peritoneal dialysis (CAPD); empirical antibiotic regimen; intraperitoneal ceftazidime; oral moxifloxacin; oral quinolones; peritoneal dialysis (PD); randomized clinical trial; renal failure