Vancomycin and netilmicin as first line treatment of peritonitis in CAPD patients

The first line treatment of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) in our hospital was recently altered from a combination of gentamicin and clindamycin, given as continuous peritoneal lavage, to one of vancomycin and netilmicin given in peritoneal dialysis fluid with prolonged dwell time (4-6 h). The change was prompted by the emergence of multiply resistant Staphylococcus epidermidis among CAPD patients and nursing staff. In 9 of 19 episodes of peritonitis treated with gentamicin/clindamycin, the infecting organism could still be isolated from peritoneal fluid 5-15 days after commencement of therapy. All of 35 culture verified episodes treated with vancomycin/netilmicin were cleared bacteriologically within 3 days (P less than 0.0005). The vancomycin and netilmicin serum levels achieved were 6.5-37.0 mg/l and 1.0-8.1 mg/l, respectively. Apart from an asthmatic reaction, possibly triggered by vancomycin, no side effects were seen. However, audiometry was not performed regularly and the possible effect of netilmicin on the residual renal function was not systematically investigated.