Document Detail

Intraperitoneal thrombolytic therapy for peritoneal dialysis-associated peritonitis.
MedLine Citation:
PMID:  9825089     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To review the literature pertaining to the use of adjunctive thrombolytic therapy for the treatment of peritoneal dialysis-associated peritonitis (PDAP). DATA SOURCES: A MEDLINE search was conducted (January 1966-December 1997) to find articles using the terms peritonitis, peritoneal dialysis, and each thrombolytic drug. References from these articles were then reviewed to identify further sources. DATA EXTRACTION: Representative case reports and clinical trials are summarized in this report. Information regarding thrombolytic dosing, administration techniques, and reported efficacy rates are included from both case reports and clinical trials. DISCUSSION: Thrombolytic agents administered intraperitoneally appear to facilitate antibiotic penetration into the biofilm formed by certain bacteria. Numerous case reports of intraperitoneal thrombolytic adjunctive therapy for recurrent or persistent PDAP have indicated that these agents may have a role in the treatment of selected patients. Urokinase and streptokinase are the only thrombolytics that have been studied. They appear to have similar efficacy, but the adverse drug event rate with streptokinase is unacceptably high. The efficacy of therapy with urokinase is probably inferior to removal of the peritoneal dialysis catheter, but, if successful, allows for the continuation of peritoneal dialysis therapy. CONCLUSIONS: In conjunction with appropriate antibiotic therapy, intraperitoneal instillation of urokinase should be reserved for patients who develop two or more episodes of recurrent or persistent PDAP in the absence of poor compliance and in whom dialysis catheter removal should be avoided (i.e., they cannot tolerate hemodialysis).
M A Worland; R S Radabaugh; B A Mueller
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  The Annals of pharmacotherapy     Volume:  32     ISSN:  1060-0280     ISO Abbreviation:  Ann Pharmacother     Publication Date:  1998 Nov 
Date Detail:
Created Date:  1999-02-02     Completed Date:  1999-02-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9203131     Medline TA:  Ann Pharmacother     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1216-20     Citation Subset:  IM    
Pharmacy Department, Deaconess Hospital, Evansville, IN, USA.
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MeSH Terms
Clinical Trials as Topic
Fibrinolytic Agents / therapeutic use
Peritoneal Dialysis / adverse effects*
Peritonitis / drug therapy*,  etiology
Thrombolytic Therapy*
Reg. No./Substance:
0/Fibrinolytic Agents

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