Newer antibiotics for the treatment of peritoneal dialysis-related peritonitis

Abstract

Peritonitis is a debilitating infectious complication of peritoneal dialysis (PD). Drug-resistant bacterial peritonitis typically has a lower response rate to antibiotics. In the past 15 years, newer antibiotics with activities against drug-resistant Gram-positive bacteria have been developed. In most circumstances, peritonitis due to methicillin-resistant staphylococci responds to vancomycin. If vancomycin cannot be used due to allergy and/or non-susceptibility, there is increasing evidence that linezolid and daptomycin are the drugs of choice. It is reasonable to start linezolid orally or intravenously, but subsequent dose reduction may be necessary in case of myelosuppression. Daptomycin can be given intravenously or intraperitoneally and has excellent anti-biofilm activity. Other treatment options for drug-resistant Gram-positive bacterial peritonitis include teicoplanin, tigecycline and quinupristin/dalfopristin. Teicoplanin is not available in some countries (e.g. the USA). Tigecycline can only be given intravenously. Quinupristin/dalfopristin is ineffective against Enterococcus faecalis and there is only low-quality evidence to support its efficacy in the treatment of peritonitis. Effective newer antibiotics against drug-resistant Gram-negative bacteria are lacking. Polymyxins can be considered, but evidence on its efficacy is limited. In this review, we will discuss the potential use of newer antibiotics in the treatment of drug-resistant bacterial peritonitis in PD patients.

Membrane adaptation limitations inEnterococcus faecalisunderlie sensitivity and the inability to develop significant resistance to conjugated oligoelectrolytes

“…2,3 All recently approved antimicrobial drugs belong to existing classes of antibiotics such as the glycopeptides (dalbavancin (2014), oritavancin (2014) and televancin (2013)) or cephalosporins (cearoline (2010)). 4,5 Unfortunately, antimicrobial discovery has not kept pace with microbial adaptation and AMR has been described for all of the existing classes of antibiotics. 5 Many promising antimicrobial compounds that are in the early stage of development, such as the recently discovered malacidin from genetic mining (targets lipid II), 6 teixobactin from soil (targets lipid II and lipid III), 2 sortase transpeptidase inhibitors (targets sortases), 7 lipoteichoic acid inhibitors, 8 antimicrobial peptides (AMPs), 9 and nisin-derived lipopeptides, 10 all target the cell envelope to some degree, although further research is needed to ensure their clinical utility.…”

Influence of different peritoneal dialysis fluids on the in vitro activity of fosfomycin against Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa

“…The emergence of drug-resistant bacteria, particularly multi-resistant Gram-negative organisms and Staphylococci, complicates the treatment of PDRP and highlights the need for new therapeutic regimens [ 7 ]. Fosfomycin demonstrates good in vitro and in vivo activity against several Gram-positive and Gram-negative organisms, excellent tissue distribution and tolerability [ 8 – 10 ].…”

Toxic shock and mortality in a dialysis patient

“…Methicillin-sensitive staph Aureus (MSSA) is sensitive to penicillin but this drug is not considered antibiotic of choice due to a higher incidence of resistance 21 . Cefazoline is the treatment of the first choice to treat MSSA because of less resistance, better tolerability and ease of use among dialysis patient as dose can be modified and administered post-hemodialysis 22 .…”