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The Use of Intraperitoneal Ampicillin in a Patient With Enterococcus faecalis Peritonitis
Natalie Greer1, Joanna Q Hudson2,3,4, Anna Jacobs2,4
1Department of Pharmacy, Union University College of Pharmacy, Jackson, TN, USA.
Insights
Intraperitoneal ampicillin may effectively treat Enterococcus faecalis peritonitis in peritoneal dialysis patients. This case study shows successful clinical cure with a modified dosing strategy, challenging current guidelines.
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.
Abstract:
Introduction: Peritoneal dialysis (PD) - associated peritonitis is a serious complication of peritoneal dialysis (PD). The 2022 International Society of Peritoneal Dialysis (ISPD) guidelines do not recommend intraperitoneal (IP) ampicillin for treatment of Enterococcal PD - associated peritonitis. To date, there is no in vivo data to support use of IP ampicillin for the treatment of Enterococcus faecalis. Case Description: A 69-year-old man with a past medical history of end stage kidney disease (ESKD) requiring continuous cycling peritoneal dialysis (CCPD) was admitted to the hospital and treated for peritonitis with E. faecalis. The patient's CCPD prescription was 2.5% Dianeal with 5 total exchanges. IP ampicillin was added to the first 4 exchanges and additional ampicillin was added to the last fill. The patient successfully completed the treatment course with clinical cure. Discussion: The use of IP ampicillin for E. faecalis peritonitis is controversial and previously lacked compelling clinical evidence for or against its use. This case demonstrates treatment of peritonitis using a modified dosing strategy with ampicillin added to each CCPD exchange and last fill. The loss of ampicillin antimicrobial activity reported in vitro with E. faecalis was not supported by this case.
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