Treatment of Candida peritonitis by peritoneal lavage with amphotericin B

Bortolussi, Robert; MacDonald, Maureen; Bannatyne, Robert M.; Bact, Dip.; Arbus, Gerald S.

doi:10.1016/s0022-3476(75)80925-5

Cited by 20 publications

(8 citation statements)

References 3 publications

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“…This strategy is supported by the observation that fungal species can invade the matrix of silastic catheters [32]. Microbiologie cure has been re ported with catheter removal in conjunction with intra peritoneal and/or intravenous amphotericin [26,29,33,34], 5-flucytosine [26,35] and intraperitoneal or intrave nous miconazole and kétoconazole [34]. However, there are isolated reports of cure with antifungal therapy alone using 5-flucytosine [3.…”

Section: Discussionmentioning

confidence: 99%

Fungal Peritonitis in Patients on Peritoneal Dialysis: Incidence, Clinical Features and Prognosis

et al. 1985

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Fungal peritonitis occurred in 17 patients on chronic peritoneal dialysis. The incidence of infection per 100 patient-dialysis months was 0.36 for patients on intermittent peritoneal dialysis and 1.6 for patients on continuous ambulatory dialysis (p < 0.005). Initial clinical findings included abdominal pain (76%), fever (59%), cloudy dialysate (76%) and poor dialysate outflow (6%). 15 patients received antibiotics within 4 weeks of developing peritonitis. All infections were caused by yeasts, with Candida parapsilosis and Candida albicans as the most common species. 14 patients were unable to continue peritoneal dialysis due to persistent or relapsing infection or the development of complications. 2 of the 3 patients who were able to continue peritoneal dialysis were treated with catheter replacement, intraperitoneal miconazole and oral ketoconazole.

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Section: Discussionmentioning

confidence: 99%

Fungal Peritonitis in Patients on Peritoneal Dialysis: Incidence, Clinical Features and Prognosis

et al. 1985

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“…Antifungal peritoneal lavage for the treatment of peritonitis associated with peritoneal dialysis was first described in the early 1970s, with both amphotericin B [159][160][161][162] and flucytosine [163].…”

Section: Peritoneal Lavagementioning

confidence: 99%

“…[159][160][161][162][163][164]. Concentrations of the drug in dialysate varying from 1 -4 µg/ml have been described [160,161] although a series of four cases [162] reported difficulties tolerating concentrations of 0.5 µg/ml. Use with systemic treatment (such as intravenous amphotericin B) was common, with only 2 out of 11 cases using intraperitoneal administration alone [159,160].…”

Section: Peritoneal Lavagementioning

confidence: 99%

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Novel modes of antifungal drug administration

Arthur¹,

Drew²,

Perfect³

2004

Expert Opinion on Investigational Drugs

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Administration of antifungals by routes other than that for which the agent was designed or approved have been utilised in attempts to provide directed therapy, reduce adverse effects and improve drug penetration into selected infection sites, such as the central nervous system, lungs and peritoneum. The most widely investigated agent utilising a novel method of drug delivery is amphotericin B. Dose forms for this agent include topicals (aerosol, nasal spray, irrigations, pastes, absorbable sponges, impregnated bone cement and gelatin), oral dosage forms (solutions, suspensions, tablets and so on) and ophthalmic preparations (drops, ointments and injections). Amphotericin B has been administered by routes such as oral, endobronchial, intrathecal, intracisternal, intra-articular, intraperitoneal, ophthalmic and as an antibiotic 'line lock'. Nystatin has been administered as an aerosol, percutaneous paste and bladder washes. Azoles, such as miconazole, fluconazole, ketoconazole and posaconazole, have been administered by novel methods but to a lesser degree. Most of these reports involve miconazole. The dose forms and routes of administration for azoles have included irrigants (bladder, joint), ophthalmic preparations (eye drops, intraocular injections, ointments), impregnated bone cement, endobronchial and intrathecal administration. Finally, both methylene blue (bladder washes) and flucytosine (peritoneal lavage, ophthalmic eye drops) have also been employed. Adequate evaluations of both the safety and efficacy of these therapies are most often hindered by prior or concomitant antifungal therapies, comorbidities and the lack of controlled clinical trials. In addition, the availability of newer treatment options, which demonstrate significant improvement in drug distribution and treatment-related adverse effects make many such novel modes of administration less practical or necessary. In contrast, the inhalation of antifungal aerosols, such as amphotericin B, is rapidly becoming a viable prophylactic option.

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“…Their report and that by Bortolussi et al (1975) suggested that short-term therapy with amphotericin B administered intravenously, intraperitoneally, or by a combination of these routes was effective in the treatment of Candida peritonitis.…”

Section: Introductionmentioning

confidence: 98%

Therapy of Candida peritonitis: penetration of amphotericin B into peritoneal fluid

Peterson

Kelty

Hall

et al. 1978

Postgraduate Medical Journal

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Summary Candida albicans peritonitis developed in a 48-year-old man with a perforated gastric ulcer who subsequently was treated with intravenous amphotericin B. The drug penetrated well into the inflamed peritoneal cavity and eradicated the organism from the peritoneal fluid. Nevertheless, at post-mortem, Candida organisms were demonstrated in a gall-bladder empyema and within the gall-bladder wall. Because intra-abdominal organs may be involved in Candida peritonitis, the use of high dose amphotericin B administered either intravenously, intraperitoneally, or both intravenously and intraperitoneally is recommended.

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Treatment of Candida peritonitis by peritoneal lavage with amphotericin B

Cited by 20 publications

References 3 publications

Fungal Peritonitis in Patients on Peritoneal Dialysis: Incidence, Clinical Features and Prognosis

Fungal Peritonitis in Patients on Peritoneal Dialysis: Incidence, Clinical Features and Prognosis

Novel modes of antifungal drug administration

Therapy of Candida peritonitis: penetration of amphotericin B into peritoneal fluid

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