Treatment Of CAPD Peritonitis Research Articles

Correlation between Hearing Loss and Peritonitis Frequency and Administration of Ototoxic Intraperitoneal Antibiotics in Patients with CAPD

Aim. Aminoglycosides have been used in the treatment of CAPD peritonitis despite their potential risk for ototoxicity. The ototoxicity risk of intraperitoneally administered aminoglycosides has been investigated by a number of studies. However, their results are somewhat conflicting. The aim of the present study was to examine the frequency of hearing loss and the correlation between the repeated doses of aminoglycosides and hearing loss in CAPD peritonitis therapy. Methods. Hearing functions of the CAPD patients who had developed peritonitis and had been treated with various antibiotics including aminoglycosides were compared with those CAPD patients who had never developed peritonitis. Threshold values for hearing were determined through “pure tone audiometry” measurements. Results. Hearing threshold levels of the patients with history of peritonitis were found to be significantly higher in both lower [pure tone averages - 1 (PTA-1)] and higher [pure tone averages - 2 (PTA-2)] frequencies, when compared to the ones with no history of peritonitis (p values were 0.001 and 0.007, respectively). Conclusion. The present study showed that intraperitoneal aminoglycoside administration in CAPD patients is associated with the development of hearing loss. The severity of hearing loss may range from mild hearing loss to profound deafness. A remarkable correlation exists between the severity of the hearing loss and the repeated and total aminoglycoside dose received.

Successful Treatment of CAPD Peritonitis Caused by Rhodotorula mucilaginosa

Successful Treatment of CAPD Peritonitis Caused by <i>Rhodotorula mucilaginosa</i>

Use of Intraperitoneal Cefepime as Monotherapy in Treatment of CAPD Peritonitis

Use of Intraperitoneal Cefepime as Monotherapy in Treatment of CAPD Peritonitis

The Treatment of CAPD Peritonitis with Vancomycin: The Genesis of New Clinical Guidelines

The Treatment of CAPD Peritonitis with Vancomycin: The Genesis of New Clinical Guidelines

Successful Treatment of Capd Peritonitis Caused by Neisseria Cinerea

Successful Treatment of Capd Peritonitis Caused by Neisseria Cinerea

ＣＡＰＤ腹膜炎の外来通院による治療プロトコールとその評価

ＣＡＰＤ腹膜炎の外来通院による治療プロトコールとその評価

Is Initial (24 Hours) Lavage Necessary in Treatment of CAPD Peritonitis?

A randomized trial was conducted to examine the influence of initial lavage on treatment of CAPD peritonitis. Patients with hypotension and shock were excluded from the trial. Thirty-six CAPD patients with acute peritonitis were randomized to treatment with intraperitoneal antibiotics including either initial 24 hours lavage before resumption of routine CAPD schedule (prior standard approach) or continued prolonged exchanges as in routine CAPD schedule. Median time to solved infection (normalization of white cell count in dialysis effluent) was identical (3 days) in the two groups. Treatment success rate was found to be 72% in the group with initial lavage and 89% in the group with prolonged exchanges. The difference in treatment success (17%) in favour of continued CAPD schedule was not found significant (95% confidence limits--1% to 35%). The results suggest lavage to be of no clinical benefit in treatment of CAPD peritonitis in patients without profound hypotension and shock.

CAPD Peritonitis and Fluoroquinolones: A Review

Fluoroquinolones are potentially useful agents in the treatment of CAPD peritonitis, due to their wide spectrum of antimicrobial activity, favourable pharmacokinetics, oral availability and their relatively low toxicity. The microbiological, pharmacokinetic, and clinical aspects of these drugs in CAPD are reviewed. Ciprofloxacin showed superior in-vitro activity in comparison with various beta lactam agents; gentamicin and vancomycin against staphylococci and particularly against Gram-negative bacteria. Its activity against streptococci is low. The in vitro activity of fluoroquinolones is reduced in peritoneal dialysis fluid. A limited rise in serum levels is observed with daily administration of fluoroquinolones in CAPD patients during 5-15 days. Effective dialysate levels are reached in most patients after oral dosing, but these levels are highly variable and low levels are often observed during the first day, and with short dwell times. Concurrent administration with phosphate binding antacids should be avoided. Initial clinical experience shows that ciprofloxacin and ofloxacin may be effective agents to treat CAPD peritonitis via the oral route. They are usually well tolerated, although convulsions have been observed. The relative efficacy in comparison with "standard therapies" will have to be shown in comparative studies.

Pharmacokinetics of once daily intra-peritoneal aztreonam and vancomycin in the treatment of CAPD peritonitis

The pharmacokinetics of aztreonam and vancomycin were studied in six adult patients who developed peritonitis during Continuous Ambulatory Peritoneal Dialysis. Aztreonam 3 g was added to the first exchange in each 24 h period with vancomycin 500 mg on the first day and 250 mg on each subsequent day (provided the pre-dose serum vancomycin concentration was less than 10 mg/l) for a total of ten days. Aztreonam and vancomycin concentrations were measured in the serum and dialysate at 1, 2, 6, 12, 18 and 24 h after the initial dose and pre-dose on days 5 and 10. By the end of the ten day study all patients had recovered clinically and had a normal dialysate. For aztreonam, the mean peak serum concentration was 84.3 mg/l (range 59.6-102.8), the mean 24 h pre-dose serum concentration was 23.0 mg/l (range 8.6-39.2) and the mean 24 h pre-dose dialysate concentration was 15.5 mg/l (range 5.0-32.0). For vancomycin, the mean peak serum concentration was 10.2 mg/l (range 8.1-12.6), the mean 24 h pre-dose concentration was 5.5 mg/l (range 3.6-6.4), and the mean 24 h pre-dose dialysate concentration was 3.4 mg/l (range 2.4-4.6). In the treatment of CAPD peritonitis, once daily intra-peritoneal administration of aztreonam 3 g with vancomycin 500 mg initially and 250 mg on subsequent days (serum concentrations permitting) provides concentrations of antibiotic in both the serum and dialysate throughout the 24 h period in excess of the inhibitory concentrations of those organisms most frequently encountered in this condition.

A comparison between oral ciprofloxacin and intra-peritoneal vancomycin and gentamicin in the treatment of CAPD peritonitis

Fifty-one patients were included in a prospective, randomized comparison of oral ciprofloxacin and intraperitoneal vancomycin/gentamicin in the treatment of CAPD peritonitis. Staphylococcal species accounted for 40% of the isolates with an equal incidence of Staphylococcus aureus and coagulase negative staphylococci. Although, overall, there was no significant difference between the regimens in outcome, ciprofloxacin was significantly less effective when peritonitis was due to coagulase negative staphylococci.

Treatment of CAPD Peritonitis with Oral Ciprofloxacin

Treatment of CAPD Peritonitis with Oral Ciprofloxacin

CAPD患者の細菌性腹膜炎に対するバンコマイシン (VCM) 療法

CAPDを施行中に急性腹膜炎を発症した男性5例, 女性2例の計7例にVCMの点滴静注または腹腔内注入を行い, その臨床的効果と安全性につき検討を行った.点滴静注はVCM 30mg/kgを1回1時間で点滴静注し, 静注後の血中濃度, CAPD液濃度を経時的に測定した. その結果, 1回投与で7日間にわたって, 10μg/ml以上の十分な有効血中濃度が得られることが判明した. CAPDにおけるVCMの腹膜よりのクリアランスは平均1.26ml/minで, 腹膜炎の治癒と共にそのクリアランスは低下傾向を認めた. またVCMの腹腔内投与はバッグ内へ初回のみ200mg, 以後100mgを注入, バッグの交換回数は2日目まで1日6回交換, 3日目より1日4回交換とし, 投与は10日間行った. 経時的にVCMの血中濃度, CAPD液濃度を測定し, 体内への吸収量を計算した. その結果, 腹腔内投与量の約70%が吸収され, 投与後24時間以内に有効血中濃度となった. また, 全例投与開始3日以内に腹膜炎症状は改善し, 5日以内に, 透析液細胞数は100/mm3以内となった.静脈内投与は5症例に7回施行したが, 副作用としては3症例の患者に軽度の筋肉痛・心悸亢進・掻痒感を認め投与中止した. 副作用の出現した3例の患者は腹腔内投与で治療を行った. 腹腔内投与例では明らかな副作用を認めなかった. 以上より, VCMの点滴静注および腹腔内投与はCAPDに併発するグラム陽性菌腹膜炎に対して有効かつ安全な療法であると思われた.

Vancomycin Tolerance in Staphylococcus Aureus Isolated during Treatment of CAPD Peritonitis

The susceptibility to vancomycin of nine staphylococcal strains responsible for nine episodes of peritonitis in patients on continuous ambulatory peritoneal dialysis was correlated with outcome of therapy. All strains examined had MIC values indicating sensitivity (MIC.:; 4 μg/ml). Tolerance was observed in one strain of Staphylococcus aureus (MIC = 1 μg/ml., MBC = 64 μg/ml). Time-kill studies using three different media demonstrated this organism's reduced susceptibility to vancomycin and suggested that testmedium composition may also affect the result. The patient with the tolerant strain, required an extended period of treatment.

Management of Peritonitis Complicating Continuous Ambulatory Peritoneal Dialysis: An Australian Perspective

In the decade following the introduction of CAPD by Popovich et al (I) substantial improvements have been made in the management of CAPD peritonitis. This review summarizes the significant advances in the prevention, diagnosis and treatment of CAPD peritonitis in the first 10 years of CAPD therapy (1976–1986) and highlights additional areas where management protocols can be improved further.