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Peritonitis is a common and clinically important complication in patients receiving peritoneal dialysis (PD). Antibiotic administration is essential for PD-related peritonitis, but routes of administration have not been established enough. Here, we performed a systematic review to assess the efficacy and safety of intraperitoneal (IP) antibiotic administration compared to intravenous (IV) antibiotic administration in patients with PD-related peritonitis. Cochrane CENTRAL, MEDLINE, and Ichushi-Web were searched in June 2017. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed, and articles were screened by four independent reviewers. Two randomized controlled trials (113 patients) were identified. IP antibiotic administration was more effective than IV antibiotic administration. The pooled risk difference between IP and IV was 0.13 (95% CI − 0.17 to 0.43). Safety assessment indicated less frequency of side effects in patients receiving IP antibiotic administration. The pooled risk ratios of IV to IP regarding adverse drug reaction-related and administration route-related side effects were 5.13 (0.63 to 41.59) and 3.00 (0.14 to 65.90), respectively. The systematic review and meta-analysis suggested that IP antibiotic administration is more effective and safer in patients with PD-related peritonitis compared to IV antibiotic administration.

The impact of intraperitoneal antibiotic administration in patients with peritoneal dialysis-related peritonitis: systematic review and meta-analysis