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Treatment of CAPD peritonitis with clavulanate potentiated ticarcillin
P Pasadakis1, E Thodis, A Euthimiadou
1Democritus University of Thrace, Division of Nephrology, General District Hospital, Alexdroupolis, Greece.
Insights
Clavulanate potentiated ticarcillin effectively treated peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. However, Pseudomonas peritonitis cases may require alternative treatment regimens for optimal outcomes.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Peritonitis is a common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Effective antibiotic therapy is crucial for managing CAPD-associated peritonitis.
Purpose of the Study:
- To evaluate the efficacy and safety of clavulanate potentiated ticarcillin (TC) as a monotherapy for CAPD peritonitis.
- To identify specific bacterial pathogens involved and assess treatment outcomes.
Main Methods:
- A total of 16 peritonitis episodes in 14 CAPD patients were treated with intraperitoneal (i.p.) clavulanate potentiated ticarcillin.
- Treatment involved an initial loading dose followed by daily exchanges with TC for ten days.
- Bacterial isolates were identified, and treatment outcomes, including recurrence and side effects, were monitored.
Main Results:
- Clavulanate potentiated ticarcillin demonstrated effectiveness as a monotherapy for CAPD peritonitis.
- Commonly isolated bacteria included Staphylococcus epidermidis, Staphylococcus aureus, and various Pseudomonas species.
- Three cases of recurrent peritonitis were observed, all associated with Pseudomonas infections, suggesting potential resistance or need for targeted therapy.
Conclusions:
- Intraperitoneal monotherapy with clavulanate potentiated ticarcillin is a viable treatment option for CAPD peritonitis.
- For Pseudomonas peritonitis, alternative or more specific therapeutic strategies may be necessary to prevent recurrence.
Abstract:
A total of 16 episodes of peritonitis in 14 patients (9 males, 5 females), were treated with Clavulanate potentiated ticarcillin (TC), a -lactamase stable parenteral penicillin. All the pts were hospitalized and received initial loading dose of 3.2 gr intraperitoneally (i.p.) in a 6-hour 1 L exchange, which was followed by four 1 L exchanges with 320 mg/LTC. The therapy was continued for ten days. The bacteria isolated were: Staph. epid. (4), Staph. aureus (2), Strept. viridans (1), Enterococcus (1), Klebsiella Pneum. (1), Serratia (1), Enterobacter (1), Pseudomonas species: stutszeri (2), cepacia (1), fluorescens (1), negative cultures (1). Recurrence of peritonitis was seen in three patients with Pseudomonas (stutszeri (2), fluorescens (1)) peritonitis, 10-16 days after cessation of therapy. No clinical or biological side effects were seen in any patient during and/or after the therapy. These results suggest that, i.p. monotherapy of TC is effective in the treatment of CAPD peritonitis, while in cases of Pseudomonas peritonitis more specific regimens should be used.