[Personal experiences in the treatment of peritonitis with a complicated extended program of peritoneal dialysis]

In 37 pts treated with peritoneal dialysis (PD) in years 1980-1990 results of peritonitis (P) treatment were compared between years 1986-90 (cycle II) and years 1980-85 (cycle I). In I cycle 47 episodes of P occurred in 9 of 21 pts treated with PD, and in cycle II 15 episodes of P in 7 of 16 dialysed pts. Treatment of P was as follows: in cycle I, daily standard PD with gentamicin and cephradine added to 2.01 dialysing exchanges; in cycle II, after initial lavage of peritoneum with a few litres of dialysing solution, 1.0 g vancomycin was given iv and continuous PD started using 1.0 litre prolonged exchanges and aminoglycosides added to dialysis solution. Treatment protocol used in cycle II was more effective than the first one: all episodes of P were immediately cured (only 32 of 47 in cycle I), there was only 1 relapse (in cycle I 6/32 cured P), duration of P was shorter (mean 6.5 days/9.8 days in cycle I) and morphological changes of peritoneum were less expressed than in cycle I. Practically important indicator of cure was decline of polynuclear cells in smear of peritoneal effluent sediment (less than 50% of cells). All 9 pts suffering from P in cycle I had to be transferred to HD (43% of all dialysed pts) and only 2 in cycle II (12% of all dialysed pts).