Abstract
BackgroundPeritonitis is a common and clinically important complication in patients receiving peritoneal dialysis (PD). Antibiotic administration is essential for PD-related peritonitis, but routes of administration have not been established enough. Here, we performed a systematic review to assess the efficacy and safety of intraperitoneal (IP) antibiotic administration compared to intravenous (IV) antibiotic administration in patients with PD-related peritonitis.MethodsCochrane CENTRAL, MEDLINE, and Ichushi-Web were searched in June 2017. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed, and articles were screened by four independent reviewers.ResultsTwo randomized controlled trials (113 patients) were identified. IP antibiotic administration was more effective than IV antibiotic administration. The pooled risk difference between IP and IV was 0.13 (95% CI − 0.17 to 0.43). Safety assessment indicated less frequency of side effects in patients receiving IP antibiotic administration. The pooled risk ratios of IV to IP regarding adverse drug reaction-related and administration route-related side effects were 5.13 (0.63 to 41.59) and 3.00 (0.14 to 65.90), respectively.ConclusionThe systematic review and meta-analysis suggested that IP antibiotic administration is more effective and safer in patients with PD-related peritonitis compared to IV antibiotic administration.
Highlights
Peritoneal dialysis (PD) is a well-established modality of renal replacement therapy for patients with end-stage renal disease
In practical cases of peritoneal dialysis (PD)-related peritonitis, proper initial management consists of diagnosis, subsequent appropriate microbiological culture sampling, and prompt empirical antibiotic therapy, followed by antibiotic de-escalation in certain cases
After the removal of duplicates and the selection by the reviewers, we identified two articles of Randomized controlled trial (RCT) met the eligibility criteria (Table 1)
Summary
Peritoneal dialysis (PD) is a well-established modality of renal replacement therapy for patients with end-stage renal disease. The most recent recommendations published in 2016 are organized into the following five sections: (1) peritonitis rate, (2) prevention of peritonitis, (3) initial presentation and management of peritonitis, (4) subsequent management of peritonitis, and (5) future research. In practical cases of PD-related peritonitis, proper initial management consists of diagnosis, subsequent appropriate microbiological culture sampling, and prompt empirical antibiotic therapy, followed by antibiotic de-escalation in certain cases. Peritonitis is a common and clinically important complication in patients receiving peritoneal dialysis (PD). Antibiotic administration is essential for PD-related peritonitis, but routes of administration have not been established enough. We performed a systematic review to assess the efficacy and safety of intraperitoneal (IP) antibiotic administration compared to intravenous (IV) antibiotic administration in patients with PD-related peritonitis
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