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Intracatheter amphotericin B retention for fungal peritonitis in continuous ambulatory peritoneal dialysis
S H Lee1, S S Chiang, S J Hseih
1Department of Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan R.O.C.
Abstract:
Two patients who developed fungal peritonitis after receiving continuous ambulatory peritoneal dialysis (CAPD) for various periods were successfully treated with intracatheter retention of amphotericin B and oral flucytosine for 5 weeks. The catheter was not removed and efficient peritoneal permeability was maintained. We suggest that intracatheter retention of antifungal agents to sterilize the catheter along with simultaneous oral antifungal agents be used to eradicate peritoneal infection. The catheter may not need to be removed, and CAPD can be accomplished. The period of hospitalization may, thereby, be shortened, and the efficiency of CAPD can be maintained.
Insights
Successful treatment of fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients was achieved using intracatheter amphotericin B and oral flucytosine. This approach avoided catheter removal, maintaining dialysis efficiency and shortening hospital stays.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Fungal peritonitis is a serious complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Traditional treatment often necessitates catheter removal, disrupting dialysis and prolonging hospitalization.
- Effective antifungal strategies are crucial for managing CAPD-associated peritonitis.
Observation:
- Two CAPD patients developed fungal peritonitis after varying treatment durations.
- Intracatheter retention of amphotericin B combined with oral flucytosine was administered for five weeks.
- Peritoneal permeability was maintained throughout the treatment period.
Findings:
- Both patients achieved successful resolution of fungal peritonitis.
- The peritoneal dialysis (PD) catheter was not removed in either case.
- This treatment regimen effectively sterilized the catheter and eradicated the infection.
Implications:
- Intracatheter antifungal agent retention, alongside oral therapy, offers a viable strategy to eradicate peritoneal infections.
- Preserving the PD catheter may be possible, allowing for continued CAPD treatment.
- This approach can potentially reduce hospitalization duration and maintain CAPD efficiency.