The case for oral treatment of peritonitis in continuous ambulatory peritoneal dialysis

Among several regimes used in the oral treatment of continuous ambulatory peritoneal dialysis (CAPD)--related peritonitis, ciprofloxacin and ofloxacin showed the higher treatment efficacy, with an overall cure rate of 80% over a treatment duration of 10-16 days. The antimicrobial activity of these agents against gram-positive episodes was equal to or even higher than that against other peritonitis episodes, and the effectiveness of oral ciprofloxacin can be further increased either by an additional intraperitoneal dose for the first 1-5 days, or by a simultaneous intraperitoneal dose of vancomycin in the first 24 hours. Clinical resistance to the new quinolones has been uncommon. The possibly increasing resistance to ciprofloxacin is a consequence of suboptimal dosing, with the resulting low local concentrations of the antibiotic. Oral treatment with quinolones provides a good therapeutic alternative to more widely used antibiotics for initial treatment of peritonitis episodes. However, more extensive data from comparative randomized studies with agents administered orally and intraperitoneally would be able to clearly elucidate the overall safety and success of oral treatment of PD-related peritonitis with quinolones or any new agent.