[Treatment of peritonitis in peritoneal dialysis. Comparison between continuous lavage with a machine and...

Since 1978, 54 episodes of PT occurred in patients treated by PD, first 26 PT (group A) were treated by CLM (40 l/day) and in situ antibiotics (AB): in the absence of Candida, the association of sulfamethoxazol (SMZ: 80 mg/l) and trimethoprime (TMP: 16 mg/l) was used. Only when a Candida was present amphotericine B (AMB: 5 mg/l) was used. CLM was continued until PT was cured. The last 29 PT (group B) were treated by 4 bags/day of CAPD with in situ AB: SMZ: 200 mg/l and TMP 40 mg/l and a systematic oral prophylaxis of Candida was performed by AMB 1,5 g/day. In group A, 5 patients died and 2 others in group B. Complications were more frequent in group A (14) than in group B (6): p less than 0.02. In group A, the AB was changed in 7 cases because of initial resistance (1) or bacterial superinfection (2) or Candida superinfection (4). In group B, AB was changed in 9 cases because of initial resistance (7) or Candida superinfection (2). In conclusion the treatment of PT by 4 bags per day with in situ AB cure PT as rapidly as CLM in spite of lower doses of SMZ - TMP. However, this method is easier to perform and give less complication than CLM. It must be the treatment of choice of PT from peritoneal dialysis.