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Initial treatment of dialysis associated peritonitis: a controlled trial of vancomycin versus cefazolin
1Department of Medicine, University of Iowa Hospital and Clinics, Iowa City 52242.
Objective:
To determine if intraperitoneal administration of vancomycin (a slowly absorbed antibiotic) improves the management of dialysis-associated peritonitis over that obtained by using cefazolin, an equally potent, rapidly absorbed antibiotic.
Setting:
A university operated teaching hospital, with patient treatment initiated at home.
Patients:
One hundred thirty-one patients trained to perform peritoneal dialysis (CAPD and CCPD) and followed at the University of Iowa Hospitals and Clinics Home Dialysis Treatment Center.
Design:
Patients were prospectively allocated into groups adding either vancomycin 25 mgm/L, or cefazolin 50 mgm/L to their dialysate when signs or symptoms of peritonitis developed. Treatment results were analysed using chi-square testing.
Findings:
Compared to cefazolin, initial peritonitis therapy with vancomycin improved the peritonitis resolution rate [67% vs 81%; p = 0.008], reduced the incidence of hospital admissions [68% vs 48%; p = 0.001], and decreased the risk of superinfection [4% vs 0%; p = 0.039].
Conclusion:
Vancomycin appeared to be superior to cefazolin in the treatment of peritoneal dialysis associated peritonitis.