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Treatment of peritonitis in CAPD with ciprofloxacin: long-term experience
M Pérez Fontán1, M Rosales, A Rodríguez-Carmona
1Nephrology Unit, Hospital Juan Canalejo, A Coruña, Spain.
Abstract:
We present the long-term results of a protocol of empirical monotherapy of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis with ciprofloxacin. One hundred and fifteen episodes of peritonitis were studied. The treatment protocol included 5 days of intraperitoneal (IP) administration of the drug, followed by 10 days of oral therapy. A good clinical response was obtained in 83% of the cases, while treatment failure was observed in 4% and relapse in 7%. A decrease in the sensitivity to ciprofloxacin of the peritonitis agents was observed in the study, with Staphylococcus spp. in particular. Three episodes of peritonitis due to bacteria resistant in vitro to ciprofloxacin responded to the treatment protocol. Ciprofloxacin attained good plasma levels both after oral and IP administration. However, dialysate levels were poor after oral administration. The most frequent side effect was gastric intolerance to oral ciprofloxacin. Two patients experienced severe adverse reactions to the drug. Ciprofloxacin may be a good choice for empirical monotherapy of CAPD-related peritonitis. However, the emergence of bacterial resistances must be carefully monitored. The drug should be administered intraperitoneally, at least to induce remission of the infection. Side effects are not frequent, but ciprofloxacin should not be considered an innocuous drug.
Insights
Ciprofloxacin effectively treats continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis with good clinical response in most cases. However, careful monitoring for emerging bacterial resistance and potential side effects is crucial.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Peritonitis is a significant complication of continuous ambulatory peritoneal dialysis (CAPD).
- Empirical monotherapy is often used for CAPD-related peritonitis.
- Ciprofloxacin is a potential agent for treating such infections.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of ciprofloxacin as empirical monotherapy for CAPD-related peritonitis.
- To assess clinical response, treatment failure, relapse rates, and adverse events.
Main Methods:
- A protocol involving 5 days of intraperitoneal (IP) ciprofloxacin followed by 10 days of oral therapy was studied.
- One hundred and fifteen episodes of CAPD-related peritonitis were analyzed.
- Bacterial sensitivity to ciprofloxacin was monitored.
Main Results:
- A good clinical response was achieved in 83% of episodes.
- Treatment failure occurred in 4% and relapse in 7% of cases.
- Decreased sensitivity to ciprofloxacin was observed, particularly in Staphylococcus species, though some resistant strains responded.
Conclusions:
- Ciprofloxacin can be a viable option for empirical monotherapy in CAPD-related peritonitis, especially with IP administration for initial remission.
- Bacterial resistance to ciprofloxacin is an emerging concern that requires monitoring.
- While generally well-tolerated, ciprofloxacin can cause side effects and should be used cautiously.