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Intraperitoneal Vancomycin Plus Either Oral Moxifloxacin or Intraperitoneal Ceftazidime for the Treatment of
Rong Xu1, Zhikai Yang1, Zhen Qu1
1Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Beijing, China.
Background:
Intraperitoneal administration of antibiotics is recommended as a first treatment for managing peritoneal dialysis (PD)-related peritonitis. However, the efficacy of oral administration of quinolones has not been well studied.
Study Design:
Randomized controlled pilot study.
Setting & Participants:
80 eligible patients with PD-related peritonitis from Peking University First Hospital (40 in each arm).
Intervention:
Intraperitoneal vancomycin, 1g, every 5 days plus oral moxifloxacin, 400mg, every day (treatment group) versus intraperitoneal vancomycin, 1g, every 5 days plus intraperitoneal ceftazidime, 1g, every day (control group).
Outcomes:
The primary end point was complete resolution of peritonitis, and secondary end points were primary or secondary treatment failure.
Measurements:
PD effluent white blood cell count.
Results:
Baseline demographic and clinical characteristics of the 2 groups were comparable. There were 24 and 22 Gram-positive organisms, 6 and 7 Gram-negative organisms, 9 and 10 culture-negative samples, and 1 and 1 fungal sample in the treatment and control groups, respectively. Complete resolution of peritonitis was achieved in 78% and 80% of cases in the treatment and control groups, respectively (OR, 0.86; 95% CI, 0.30-2.52; P=0.8). There were 3 and 1 cases of relapse in the treatment and control groups, respectively. Primary and secondary treatment failure rates were not significantly different (33% vs 20% and 10% vs 13%, respectively). In each group, there was 1 peritonitis-related death and 6 transfers to hemodialysis therapy. During the 3-month follow-up period, 7 and 3 successive episodes of peritonitis occurred in the treatment and control groups, respectively. Only 2 adverse drug reactions (mild nausea and mild rash, respectively) were observed in the 2 groups.
Limitations:
Sample size was relatively small and the eligibility ratio was low. Also, the number of peritonitis episodes was low, limiting the power to detect a difference between groups.
Conclusions:
This pilot study suggests that intraperitoneal vancomycin with oral moxifloxacin is a safe, well-tolerated, practical, and effective first-line treatment for PD-related peritonitis. Larger adequately powered clinical trials are warranted.
Insights
Oral moxifloxacin combined with intraperitoneal vancomycin offers a safe and effective first-line treatment for peritoneal dialysis (PD)-related peritonitis. This pilot study indicates good tolerability and practicality for managing PD peritonitis.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Peritoneal dialysis (PD)-related peritonitis is typically managed with intraperitoneal antibiotics.
- The effectiveness of oral quinolone antibiotics for PD peritonitis remains understudied.
Purpose of the Study:
- To evaluate the efficacy and safety of oral moxifloxacin as a first-line treatment for PD-related peritonitis.
Main Methods:
- A randomized controlled pilot study involving 80 patients with PD-related peritonitis.
- Treatment group: intraperitoneal vancomycin plus oral moxifloxacin.
- Control group: intraperitoneal vancomycin plus intraperitoneal ceftazidime.
Main Results:
- Complete peritonitis resolution rates were similar: 78% (treatment) vs. 80% (control).
- Treatment failure rates and adverse drug reactions were not significantly different between groups.
- The combination of oral moxifloxacin and intraperitoneal vancomycin demonstrated safety and tolerability.
Conclusions:
- Oral moxifloxacin with intraperitoneal vancomycin is a safe, well-tolerated, and effective first-line option for PD peritonitis.
- Limitations include a small sample size and low eligibility ratio, necessitating larger trials.
- Further research with adequately powered clinical trials is recommended.
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