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Once-daily intraperitoneal gentamicin is effective therapy for gram-negative CAPD peritonitis
W C Lye1, J C van der Straaten, S O Leong
1Mount Elizabeth Medical Centre, Department of Medicine, National University Hospital, Singapore, Singapore.
Summary
Once-daily intraperitoneal gentamicin shows effectiveness in treating gram-negative peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. This study evaluated its 3-year use, finding a notable success rate in managing these infections.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Peritonitis is a common complication in continuous ambulatory peritoneal dialysis (CAPD).
- Gram-negative bacterial infections pose a significant challenge in CAPD peritonitis management.
- Optimizing antibiotic regimens is crucial for successful treatment outcomes.
Purpose of the Study:
- To assess the efficacy of a once-daily intraperitoneal (IP) gentamicin regimen.
- To evaluate the treatment outcomes for gram-negative CAPD peritonitis over a 3-year period.
- To analyze the impact of specific pathogens and resistance on treatment success.
Main Methods:
- A prospective cohort study was conducted.
- Patients with new episodes of CAPD peritonitis received empirical IP vancomycin and gentamicin.
- Gentamicin was administered at a single daily dose of 40 mg/2 L in the overnight exchange bag.
Main Results:
- Gram-negative organisms were isolated in 32.6% of 190 peritonitis episodes.
- Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter spp. were among the common gram-negative pathogens.
- The overall treatment success rate was 66.1%, improving when Pseudomonas infections and gentamicin-resistant pathogens were excluded.
Conclusions:
- Once-daily IP gentamicin demonstrates effectiveness in treating gram-negative CAPD peritonitis.
- The regimen offers a viable option for managing these challenging infections.
- Further studies may explore optimizing gentamicin use in specific resistant cases.