Single-Dose Intraperitoneal Vancomycin and Oral Ciprofloxacin for the Treatment of Peritonitis in Capd Patients: Preliminary Report

Nye, K.; Gibson, Suzanne; Nwosu, Azikiwe; Manji, Mav; Robinson, Brian H.; Hawkins, J. B.

doi:10.1177/089686089301300112

Cited by 11 publications

(3 citation statements)

References 5 publications

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“…The use of IP vancomycin with oral ciprofloxacin is also common, although this regimen is not in the International Society for Peritoneal Dialysis (ISPD) guidelines. This combination is effective and the use of an oral agent makes this a simple regimen to administer (14,15). Reports of relapse after fluoroquinolone treatment lessened the initial enthusiasm for this combination (16).…”

Section: Discussionmentioning

confidence: 99%

A Survey of CAPD Peritonitis Management and Outcomes in North and South Thames NHS Regions (U.K.): Support for the ISPD Guidelines

Kent

Almond

2000

Perit Dial Int

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Objective This survey examined the current management of continuous ambulatory peritoneal dialysis (CAPD) peritonitis and the effectiveness of the various antibiotic protocols in use. Design The information required was elicited via a postal questionnaire. Setting The questionnaire was posted to each renal dialysis unit offering CAPD throughout the North and South Thames National Health Service regions. Patients All patients using CAPD at each responding unit were eligible for inclusion. Main Outcome Measures Each unit provided details of their CAPD peritonitis episodes for 1997. Each unit's empirical treatment regimen for CAPD peritonitis was sought in addition to response rates. Also requested were numbers for peritonitis episodes, recurrences, and negative cultures, plus the peritonitis rate per patient-month. Results Thirteen units returned the questionnaire (87% of the survey population). Nine of the 13 units were using vancomycin regimens, with the remainder using cephalosporin regimens. The results were compared to the audit standards of the British Renal Association. Seventy percent of units reached the 80% mark for response rate; similar results were achieved with both the vancomycin and cephalosporin regimens. Ninety-two percent achieved the suggested peritonitis rate of 1 episode every 18 patient-months; 30% achieved the culture-negative rate of 10%. The average recurrence rate was 19%. Conclusion The units contacted achieved most of the standards suggested by the British Renal Association; however, wide variations did exist. Recent guidelines have suggested avoiding vancomycin-based regimens in order to reduce the incidence of vancomycin resistance. The suggested regimen of a cephalosporin with an aminoglycoside seems to represent a suitable alternative.

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Section: Discussionmentioning

confidence: 99%

A Survey of CAPD Peritonitis Management and Outcomes in North and South Thames NHS Regions (U.K.): Support for the ISPD Guidelines

Kent

Almond

2000

Perit Dial Int

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“…Ciprofloxacin was chosen for its efficacy not only against gram-negative bacteria, including Pseudomonas aeruginosa, but also against Staphylococcus and Streptococcus spp and its excellent bioavailability after oral administration, even in severe infections (9). Oral ciprofloxacin and other fluoroquinolones have been previously used in high-dosage monotherapy for PD peritonitis but with discordant success rates: 10% (27), 76% (28), 83% (29), 90% (30), and 94% (31). In the latter study, Nye et al used ciprofloxacin in association with IP vancomycin, suggesting that quinolones should be used in association with a glycopeptide to ensure coverage of gram-positive cocci (31).…”

Section: Discussionmentioning

confidence: 99%

“…Oral ciprofloxacin and other fluoroquinolones have been previously used in high-dosage monotherapy for PD peritonitis but with discordant success rates: 10% (27), 76% (28), 83% (29), 90% (30), and 94% (31). In the latter study, Nye et al used ciprofloxacin in association with IP vancomycin, suggesting that quinolones should be used in association with a glycopeptide to ensure coverage of gram-positive cocci (31). Failure resulted in some cases from the resistance of Staphylococcus spp (especially the methicillin-resistant S. aureus) to quinolones (27)(28)(29), a finding also observed in 7 of our cases.…”

Section: Discussionmentioning

confidence: 99%

Vancomycin and Ciprofloxacin: Systemic Antibiotic Administration for Peritoneal Dialysis-Associated Peritonitis

Goffin

Herbiet

Pouthier³

et al. 2004

Perit Dial Int

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Objectives Peritonitis due to peritoneal dialysis (PD) is best treated empirically while waiting for the results of the dialysate culture. Thus, antibiotic therapy must cover both gram-positive and gram-negative micro-organisms. First, over a period of 9 years in a multicenter study we evaluated the efficiency of a vancomycin and ciprofloxacin combination given as the first-line treatment protocol for PD peritonitis. Second, we evaluated whether a systemic route of administration of the antibiotics could be an interesting alternative to the usual cumbersome intraperitoneal drug administration. Methods Vancomycin 15 mg/kg body weight, intravenous, and oral ciprofloxacin 250 mg two times per day (500 mg twice per day if residual creatinine clearance was above 3 mL/minute) were prescribed at diagnosis of peritonitis. Vancomycin injections were repeated (when blood trough level was expected to be below 12 μg/mL) in cases of gram-positive organisms for a total duration of 3 weeks. Ciprofloxacin was given for a total of 3 weeks in cases of gram-negative and a total of 10 days for susceptible gram-positive infections. Results A total of 129 episodes of peritonitis occurred; 28 of them were not included in the study because of protocol violation ( n = 15) or fungal ( n = 7) or fecal ( n = 6) peritonitis, leaving 101 peritonitis episodes for analysis. 52 (51.5%) gram-positive and 28 (27.7%) gram-negative organisms were grown; 38 gram-positive organisms were coagulase-negative staphylococci. No organism was identified in 8 peritonitis episodes, whereas 13 peritonitis episodes were caused by more than 1 organism. 35% of the coagulase-negative staphylococci were resistant to first-generation cephalosporin and methicillin, whereas all were susceptible to vancomycin. For gram-negative bacilli, the susceptibility rate was 96% and 95% for ciprofloxacin and ceftazidime respectively. The overall treatment success rate was 77.2% (78 of the 101 peritonitis episodes): 61.4% at first intention and 15.8% after optimization of the antibiotic therapy (second intention). The protocol failed in 22.8% of the peritonitis episodes. Hospitalization was required in 52% of the peritonitis episodes; average hospitalization was 11 (range 1 – 45) days. Conclusion Systemic vancomycin and ciprofloxacin administration is a simple and efficient first-line protocol antibiotic therapy for PD peritonitis. In our opinion, vancomycin should still be used for gram-positive infections because of its high susceptibility rate compared with first-generation cephalosporins, providing a close monitoring of the local epidemiology. Oral ciprofloxacin provides satisfactory results in gram-negative infections, comparable to those obtained with intraperitoneal ceftazidime or aminoglycosides.

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New Peritoneal Dialysis Solutions and Solutions on the Horizon

Feriani¹,

Krediet

2009

Nolph and Gokal’s Textbook of Peritoneal Dialysis

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Single-Dose Intraperitoneal Vancomycin and Oral Ciprofloxacin for the Treatment of Peritonitis in Capd Patients: Preliminary Report

Cited by 11 publications

References 5 publications

A Survey of CAPD Peritonitis Management and Outcomes in North and South Thames NHS Regions (U.K.): Support for the ISPD Guidelines

A Survey of CAPD Peritonitis Management and Outcomes in North and South Thames NHS Regions (U.K.): Support for the ISPD Guidelines

Vancomycin and Ciprofloxacin: Systemic Antibiotic Administration for Peritoneal Dialysis-Associated Peritonitis

New Peritoneal Dialysis Solutions and Solutions on the Horizon

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