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Oral treatment of peritonitis in CAPD patients with ofloxacin
Abstract:
Eighteen episodes of peritonitis in 16 CAPD patients were treated with oral ofloxacin 400 mg initially, followed by 300 mg daily for a total of 10 days. The culture-positive rate was 72.2% with Staphylococcal species as the most frequent isolates. The overall cure rate as defined by negative cultures 1 and 2 months after discontinuation of antibiotics was 83.3%. The time taken for the peritoneal effluent to clear completely was 5 days. With such a dosing regime, there was a significant increase in the mean serum trough level of ofloxacin from 2.28 mg/l on day 1 to 5.83 mg/l on day 10 (P less than 0.001). There was no significant difference in the serum levels attained whether or not phosphate binders were concurrently given. Side-effects were nausea and non-specific dizziness. No patients had to discontinue treatment because of side-effects. Ofloxacin appeared to diffuse from the blood into the peritoneal fluid, and a highly significant correlation existed between simultaneous blood and peritoneal effluent ofloxacin levels (r = 0.88, P less than 0.0001).
Insights
Oral ofloxacin effectively treated peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients, achieving an 83.3% cure rate. This antibiotic regimen demonstrated good peritoneal penetration and was well-tolerated, with minimal side effects.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Peritonitis is a serious complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Effective antibiotic treatment is crucial for managing CAPD-associated peritonitis.
Purpose of the Study:
- To evaluate the efficacy and safety of oral ofloxacin for treating CAPD peritonitis.
- To assess ofloxacin's pharmacokinetic profile, including serum and peritoneal fluid levels.
Main Methods:
- 18 episodes of peritonitis in 16 CAPD patients were treated with oral ofloxacin (400 mg initial dose, then 300 mg daily for 10 days).
- Culture-positive rates, cure rates (negative cultures at 1 and 2 months post-treatment), and time to effluent clearance were assessed.
- Serum trough levels of ofloxacin were measured on days 1 and 10. Correlation between blood and peritoneal fluid levels was analyzed.
Main Results:
- The culture-positive rate was 72.2%, with Staphylococcal species being the most common isolates.
- An overall cure rate of 83.3% was achieved.
- Peritoneal effluent cleared completely in a mean of 5 days.
- Serum trough levels of ofloxacin significantly increased from day 1 to day 10 (2.28 mg/l to 5.83 mg/l).
- A strong correlation (r=0.88) was observed between simultaneous blood and peritoneal fluid ofloxacin levels.
- Side effects were limited to nausea and dizziness, with no treatment discontinuations.
Conclusions:
- Oral ofloxacin is an effective and well-tolerated treatment for CAPD peritonitis.
- The dosing regimen leads to adequate serum levels and good penetration into peritoneal fluid.
- Ofloxacin represents a viable therapeutic option for managing this common complication in CAPD patients.