Sixty patients were enrolled In a prospective, randomized study to evaluate the efficacy of two different regl mens for the empirical treatment of continuous ambulatory peritoneal dialysis (CAPD) peritonitis. At presentation, Group I received Intraperitoneal vancomycin (1 g) and oral pefioxacin (400 mg b.l.d.), and Group II Intraperitoneal vancomycin (1 g) and gentamicin (80 mg loading dose, followed by 15 mg/2 L). Treatment duration was 14 days. Despite randomization, Group I had significantly more patients with primary Candida peritonitis. When fungal peritonitis was excluded from analysis, there were no significant differences In the treatment success rate (Group I, 73.3% vs Group II, 80.0%, p=NS), number of relapses (Group 1,0 vs Group II, 1), and Tenckhoff catheter removal rates (Group 1,26.6% vs Group 11,16.6%, p=NS) between the two groups. The patients treated with pefioxacin had an increased incidence of nausea and vomiting. In selected situations oral pefioxacin may be a suitable substitute for intraperitoneal gentamicin as outpatient therapy for CAPD peritonitis.
The extent of pre-dialysis anaemia in Asian patients and the contribution of gastrointestinal blood loss to anaemia are unknown. O f 76 new dialysis patients in our unit in 1994, 7.9% of patients had a haemoglobin (Hb)<6 g/dL; 53.9% had Hb 26 -<8 g/dL; 28.9% had an Hb28 -<10 g/dL and 9.2% had Hb2lO g/dL in the 2 months before dialysis. Gastroduodenoscopy in 38 patients 2 months pre-dialysis (excluding 1 patient each with chronic duodenal ulcer and overt haemorrhagic gastritis), showed that 16.7% were normal, while the rest had mucosal erythema, erosions or petechiae alone or in combination. Haemoglobin was significantly lower in patients with endoscopic petechiae (n=23, Hb 7.24k1.28 g/dL) compared with those without (n=13, Hb 8.35k1.29 g/dL), although preceding blood transfusions were similar. No differences in Hb were noted in patients with or without endoscopic erythema or erosions, respectively. It is possible that occult blood loss associated with gastroduodenal petechiae exacerbates anaemia in chronic renal failure (CRF).
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