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Ciprofloxacin in the treatment of gram-positive bacterial peritonitis in patients undergoing CAPD
M Pérez-Fontán1, M Rosales, F Fernández
1Division of Nephrology, Hospital Juan Canalejo, A Coruña, Spain.
Abstract:
Fluoroquinolones may be a good alternative for the treatment of bacterial peritonitis in patients undergoing continuous ambulatory peritonitis dialysis (CAPD). To test their efficiency against Gram-positive bacteria, we treated with intraperitoneal (i.p.) ciprofloxac in 30 episodes of Gram-positive bacterial peritonitis without manifest tunnel infection of the peritoneal catheters. Treatment was sustained for 5 days, then orally for 10 further days. Clinical and bacteriological responses were satisfactory in 25 cases, but resolution of infection was slow in 5 cases of Staphylococcus aureus. The minimal inhibitory and bactericidal concentrations were 0.0625-0.50 and 0.125-1.0 micrograms/mL respectively, lower than the plasma and dialysate concentrations of the drug. Side effects were negligible. We conclude that ciprofloxacin provides a good therapeutic alternative to more widely used antibiotics for the empirical treatment of peritonitis in patients undergoing CAPD. However, combinations of antibiotics may be necessary, in Staphylococcus aureus peritonitis.
Insights
Ciprofloxacin is an effective treatment for Gram-positive bacterial peritonitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). While generally successful, Staphylococcus aureus infections may require combination antibiotic therapy.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Bacterial peritonitis is a common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Effective antibiotic treatment is crucial for managing peritonitis and preventing complications.
Purpose of the Study:
- To evaluate the efficacy and safety of ciprofloxacin for treating Gram-positive bacterial peritonitis in CAPD patients.
- To determine the in vitro activity of ciprofloxacin against causative pathogens.
Main Methods:
- A study involving 30 episodes of Gram-positive bacterial peritonitis in CAPD patients treated with intraperitoneal (i.p.) ciprofloxacin.
- Treatment involved 5 days of i.p. administration followed by 10 days of oral therapy.
- Minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) were determined.
Main Results:
- Satisfactory clinical and bacteriological responses were observed in 25 out of 30 cases.
- Slower resolution of infection was noted in 5 cases of Staphylococcus aureus peritonitis.
- MIC and MBC values were low (0.0625-0.50 and 0.125-1.0 µg/mL, respectively), indicating potent in vitro activity.
Conclusions:
- Ciprofloxacin is a viable alternative antibiotic for empirical treatment of peritonitis in CAPD patients.
- Combination antibiotic therapy may be necessary for treating Staphylococcus aureus peritonitis.
- Ciprofloxacin demonstrated a favorable safety profile with negligible side effects.