Treatment in Pd Patients of Peritonitis Caused by Gram-Positive Organisms with Single Daily Dose of Antibiotics

This study was a retrospective case analysis of treatment results of peritonitis in PD patients caused by gram-positive organisms in two different but comparable periods. Cases were entered, regardless of status of exit site, or whether it was the patient's first or subsequent peritonitis episode. Failure was defined as either recurrence of peritonitis (with same organism within four weeks of cessation of treatment) or the therapeutic decision to remove the catheter. Cefazolin used in doses of 1.5 g once a day intraperitoneally (1.0 g if body weight was < 50 kg) with initial tobramycin until culture results became available resulted in a 77% overall cure rate compared to 74% cure in a similar group treated with vancomycin 2.0 g IP weekly (1.0 g if body weight < 50 kg). Peritonitis caused by methicillin-resistant coagulase-negative staphylococci showed a high failure rate; the change to vancomycin after the initial treatment of these cases would be justified. The cure rate of peritonitis caused by S. aureus is disappointingly low (58% with vancomycin, 67% with cefazolin). This is due to the high rate of exit-site infections with this organism.