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Flucytosine-miconazole treatment of Candida peritonitis. Its use during continuous ambulatory peritoneal dialysis
Abstract:
A case of Candida parapsilosis peritonitis occurred in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD). Treatment with oral doses of flucytosine and intravenous doses of miconazole was effective. No interruption in CAPD was necessary, and acceptable flucytosine levels were obtained in the serum and dialysate. This case and information available in the literature suggest that Candida peritonitis can be treated effectively with antimicrobial agents that are well tolerated by the patient, and removal of the dialysis catheter is not always necessary for cure.
Insights
Candida peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients can be effectively treated with oral flucytosine and intravenous miconazole. Treatment allowed uninterrupted dialysis, suggesting catheter removal is not always necessary for cure.
Area of Science:
- Medical Mycology
- Nephrology
- Infectious Diseases
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a common treatment for end-stage renal disease.
- Peritonitis is a serious complication of CAPD, with fungal infections posing a particular challenge.
- Candida species are an important cause of fungal peritonitis in CAPD patients.
Observation:
- A case of Candida parapsilosis peritonitis was observed in a patient undergoing CAPD.
- The patient was treated with oral flucytosine and intravenous miconazole.
- Serum and dialysate flucytosine levels were monitored and found to be acceptable.
Findings:
- The combined oral flucytosine and intravenous miconazole treatment was effective in resolving the Candida peritonitis.
- The patient was able to continue CAPD without interruption throughout the treatment course.
- Adequate therapeutic drug levels of flucytosine were achieved in both serum and peritoneal dialysate.
Implications:
- This case suggests that Candida peritonitis in CAPD patients can be managed effectively with well-tolerated antimicrobial agents.
- Preservation of the dialysis catheter and continuation of CAPD may be possible, avoiding the need for catheter removal in many cases.
- This approach could lead to better patient outcomes and reduced treatment burden for CAPD-associated fungal peritonitis.