Antimicrobial treatment of peritonitis associated with continuous ambulatory peritoneal dialysis

A multitude of therapeutic regimens have been proposed for the management of peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). There are, however, few clinical trials that have evaluated the efficacy of these proposed regimens in a prospective, comparative fashion. This retrospective report is a tabulation of the published data on antimicrobial treatment of CAPD-related peritonitis. The results are presented for combination and mono-drug therapies; Gram-positive bacterial, Gram-negative bacterial and fungal infections; intravenous, oral and intraperitoneal (i.p.) routes of drug administration; various dosages and dosing intervals; and clinical response and relapse rates. The apparent optimal combination regimen for empiric treatment of peritonitis is vancomycin administered in 1 dialysis exchange/week with ceftazidime. This regimen avoids the toxicity associated with the use of aminoglycosides while maintaining effectiveness.