Treatment of bacterial peritonitis with once-daily dose of intraperitoneally antibiotics

Abstract

Objectives: to determine if the treatment of the bacterial peritonitis in patients with end-stage renal disease treated by continuous ambulatory peritoneal dialysis with intraperitoneal antibiotics once a day with intermittent administration has the same therapeutic effect as it has been described in the universal literature (in each bag of peritoneal exchange).

Design: intervention study with historical control (taken from the universal literature)

Place: Renal Unit of the Service of Renal Therapy (STR) of Caldas, Santa Sofía Hospital, Manizales, Colombia.

Methods: patients with confirmed peritonitis were given an intraperitoneal empiric antibiotic regime that covered bacterial Gram (+) and Gram (­) infections. The regime included Cephradine (15 mg/kg) and Gentamicine (0,6 mg/kg) once a day with a minimum time of 6 hours in the peritoneal cavity; in case there were no good results after 48 hours, a second antibiotic was added depending upon the result of the Gram culture and the sensitivity shown in the peritoneal fluid.

Results: during the study period there were 251 episodes of peritonitis among 157 patients that were seen in 2004 and 175 patients in 2005; 21 episodes were excluded: 3 patients died due to cardiovascular causes before the results of the antibiotic therapy were known, 5 patients didn't bring the peritoneal fluid for the study, and 13 episodes of candida. 230 episodes were finally considered, 35 episodes (15.21%) for Gram (­) organisms, 105 episodes (46.65%) Gram (+) organisms and 90 episodes (39%) for unidentified organisms. 168 episodes (73% of the patients) responded successfully to once a day antibiotics, in 31 episodes (16% of the patients) the use of a second antibiotic was necessary, this last was oral Ciprofloxacin or intraperitoneal Ceftriaxone for Gram (­) organisms, Vancomycin for Gram (+) organisms and the association of Vancomycin and Ciprofloxacin for an unidentified organism. In 21 episodes there was no improvement making it necessary to remove the peritoneal catheter and to put the patient in hemodialysis. 4 patients died of sepsis during the treatment 2 of infection due to Gram (­) organisms, 1 of Gram (+) organisms and 1 of unidentified organisms. The amount of relapses of peritonitis was not established, defined as another episode of peritonitis with the same genus/species that caused the preceding episode of peritonitis four weeks after completing the course of antibiotics.

Conclusions: the administration of intraperitoneal empiric antibiotics once a day to cover Gram (+) and Gram (­) organisms has the same therapeutic effect as shown in the historical outline (taken from the universal literature) with the same antibiotics given in intermittent way, with the benefits of less toxicity and more comfort for the patients.