Document Detail


The recommendations from the International Society for Peritoneal Dialysis for Peritonitis Treatment: a single-center historical comparison.
MedLine Citation:
PMID:  15384800     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The antibiotic treatment currently recommended by the International Society for Peritoneal Dialysis (ISPD) for peritonitis consists of a combination of a first- and a third-generation cephalosporin. The schedule formerly recommended combined a first-generation cephalosporin and an aminoglycoside. No comparison between the treatment schedules has been performed until now. We compared the effectiveness of these two regimens in peritoneal dialysis-related peritonitis at our center. From January 1999 to April 2000, we followed 107 patients in our PD clinic (period 1: 47% men; 32% with diabetes; mean age: 52 +/- 13 years). We followed a similar number of patients from January 2002 to July 2003 (period 2: 109 patients; 54% men; 51% with diabetes; mean age: 56 +/- 18 years). In each period, diagnosis and treatment of peritonitis were based on the recommendations of the ISPD as earlier described. Negative culture rates were similar in period 1 and period 2 (32% vs. 30%). In both study groups, the bacteria that most commonly caused peritonitis were Staphylococcus epidermidis (period 1: 41%; period 2: 39%) and S. aureus (period 1: 27%; period 2: 18%). Gram-positive infections occurred in 59% of patients during period 1 and in 57% during period 2. Gram-negative infections occurred in 16% of patients during period 1 and in 18% during period 2. We observed no significant difference in the peritonitis cure rate from period 1 to period 2 (78% vs. 83%; chi-square: 0.98; p = 0.3), but changes in the primary antibiotic schedule were necessary in 4 patients in period 1 as compared with 1 patient in period 2. The rates of catheter removal were not significantly different during the two periods (period 1: 14%; period 2: 5%; chi-square: 2.5; p = 0.11). Mortality was also not significantly different during the two periods (period 1: 7%; period 2: 5%; chi-square: 0.23; p = 0.62). The two antibiotic schedules were equally effective in the treatment of peritonitis. Cost-effectiveness, impact on residual renal function, and potential development of bacterial resistance must be considered when selecting the antibiotic schedule for peritonitis treatment.
Authors:
Margarete M Silva; Roberto Pecoits-Filho; Carla S Rocha; Andréa E M Stinghen; Maria A Pachaly; Marcelo M Nascimento; Rodrigo P Campos; Sirlene Sauthier; Roseana Fuerbringer; Miguel C Riella
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Advances in peritoneal dialysis. Conference on Peritoneal Dialysis     Volume:  20     ISSN:  1197-8554     ISO Abbreviation:  Adv Perit Dial     Publication Date:  2004  
Date Detail:
Created Date:  2004-09-23     Completed Date:  2004-11-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9104803     Medline TA:  Adv Perit Dial     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  74-7     Citation Subset:  IM    
Affiliation:
Evangelic School of Medicine, Curitiba, Brazil.
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MeSH Terms
Descriptor/Qualifier:
Ceftazidime / administration & dosage
Cephalothin / administration & dosage
Drug Administration Schedule
Drug Therapy, Combination / therapeutic use*
Female
Gentamicins / administration & dosage
Humans
Male
Middle Aged
Peritoneal Dialysis / adverse effects*
Peritonitis / drug therapy*,  etiology,  microbiology
Practice Guidelines as Topic
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Gentamicins; 153-61-7/Cephalothin; 78439-06-2/Ceftazidime

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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