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Intraperitoneal thrombolytic therapy for peritoneal dialysis-associated peritonitis
M A Worland1, R S Radabaugh, B A Mueller
1Pharmacy Department, Deaconess Hospital, Evansville, IN, USA.
The Annals of Pharmacotherapy
|November 24, 1998
Summary
Adjunctive thrombolytic therapy, particularly urokinase, may help treat recurrent peritoneal dialysis-associated peritonitis (PDAP) by improving antibiotic penetration. This approach is best reserved for select patients to avoid catheter removal.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Peritoneal dialysis-associated peritonitis (PDAP) is a common complication.
- Recurrent or persistent PDAP poses a treatment challenge.
- Biofilm formation by bacteria can impede antibiotic efficacy.
Observation:
- Literature review of thrombolytic therapy for PDAP from 1966-1997.
- Analysis of case reports and clinical trials on urokinase and streptokinase.
- Assessment of dosing, administration, efficacy, and adverse events.
Findings:
- Intraperitoneal thrombolytics may enhance antibiotic penetration into bacterial biofilms.
- Urokinase and streptokinase show similar efficacy, but streptokinase has a high adverse event rate.
- Urokinase therapy may be less effective than catheter removal but allows PD continuation.
Implications:
- Intraperitoneal urokinase is a potential adjunctive treatment for selected recurrent PDAP cases.
- Reserve urokinase for patients with multiple PDAP episodes who cannot tolerate hemodialysis.
- Further research may be needed to optimize thrombolytic therapy for PDAP.