The Use of Intraperitoneal Ampicillin in a Patient With Enterococcus faecalis Peritonitis

Area of Science:

• Nephrology
• Infectious Diseases
• Pharmacology

Background:

• Peritoneal dialysis (PD)-associated peritonitis is a significant complication.
• Current 2022 International Society of Peritoneal Dialysis (ISPD) guidelines do not recommend intraperitoneal (IP) ampicillin for Enterococcal peritonitis.
• Limited in vivo data exists for IP ampicillin in treating Enterococcus faecalis infections.

Observation:

• A 69-year-old continuous cycling peritoneal dialysis (CCPD) patient with end-stage kidney disease (ESKD) presented with E. faecalis peritonitis.
• Treatment involved a modified IP ampicillin dosing strategy: ampicillin added to the first 4 exchanges and the final fill of CCPD.
• The patient achieved a clinical cure following the treatment course.

Findings:

• This case demonstrates successful treatment of E. faecalis peritonitis using a modified IP ampicillin regimen.
• The observed clinical cure contradicts in vitro findings suggesting loss of ampicillin activity against E. faecalis.
• The modified dosing strategy involved ampicillin in each CCPD exchange and the last fill.

Implications:

• This case provides in vivo evidence supporting the potential efficacy of IP ampicillin for E. faecalis peritonitis.
• Findings may prompt re-evaluation of current ISPD guidelines regarding ampicillin use in PD-associated Enterococcal peritonitis.
• Further research is warranted to validate this modified dosing strategy in a larger patient cohort.