Low dose intraperitoneal ciprofloxacin for the treatment of peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD)

Dryden, Matthew; Wing, A. J.; Phillips, Ian

doi:10.1093/jac/28.1.131

Cited by 10 publications

(6 citation statements)

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“…There is now ample experience in the use of quinolones for the treatment of PD-related peritonitis. Ciprofloxacin has been reported on most frequently (9-14,18,20-25) but other related drugs, including ofloxacin, levofloxacin, and pefloxacin, have also been used in this setting (15-17). Quinolones have been used alone and in association with other antimicrobials, and both oral and IP routes have been employed successfully.…”

Section: Discussionmentioning

confidence: 99%

“…Older quinolones [including ciprofloxacin (Cpx)] have demonstrated an equilibrated activity against gram-positive and gram-negative bacteria (including Pseudomonas aeruginosa), while newer quinolones show improved activity against gram-positives, Chlamydia spp, Mycoplasma spp, mycobacteria, and selected anaerobes (8). Oral and intraperitoneal (IP) quinolones have been extensively used for the management of PD-related peritonitis, with overall satisfactory results (9)(10)(11)(12)(13)(14)(15)(16)(17)(18). However, and similarly to other antibiotics, development of bacterial resistance may compromise the long-term results of this family of antimicrobials.…”

Section: Treatment Of Peritonitis and Exit-site Infectionsmentioning

confidence: 99%

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Treatment of Peritoneal Dialysis-Related Peritonitis with Ciprofloxacin Monotherapy: Clinical Outcomes and Bacterial Susceptibility over Two Decades

et al. 2009

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Background There is controversy about the preferred initial antibiotic therapy for peritoneal dialysis (PD)-related peritonitis. Quinolones have been used extensively in this setting, yet their long-term effectiveness is unknown. Aim To analyze the results of a protocol of treatment of PD-related peritonitis with ciprofloxacin, maintained over two decades. Method We analyzed the clinical outcome of 682 episodes of bacterial peritonitis treated with intraperitoneal ciprofloxacin monotherapy, and the time course of bacterial susceptibility to this antimicrobial, in a historical cohort of 641 PD patients (1988-2007). Main outcome variables included changes to initial therapy and rates of hospital admission, catheter removal, relapse, reinfection, PD dropout, and mortality. For comparisons we divided the study period into phases A (1988-1994), B (1995-2000), and C (2001-2007). Results The incidence of Staphylococcus aureus peritonitis decreased, while the incidences of polymicrobial and negative-culture peritonitis increased after phase A. In vitro susceptibility to ciprofloxacin decreased significantly only among coagulase-negative staphylococci (87.0% susceptible strains in phase A vs 70.0% in B and 70.1% in C, p = 0.006). Overall success rates (catheter not removed and ongoing PD after the episode) remained stable, at over 85%. However, the proportion of patients treated solely with ciprofloxacin declined from 75.7% (A) to 47.3% (B) to 32.4% (C) ( p < 0.0005) and admission rates increased from 12.7% to 16.8% to 24.9% respectively ( p = 0.001). These changes affected all the etiologic groups except culture-negative peritonitis. In vitro resistance to ciprofloxacin was a marker of multiresistance and correlated strongly with clinical outcome of peritonitis. Among isolates susceptible to ciprofloxacin, changing initial therapy for any reason also predicted a poor outcome. Conclusions Following satisfactory early results, the effectiveness of ciprofloxacin as monotherapy for PD-related peritonitis has declined markedly in the long term. This decline cannot be explained solely by a decrease of in vitro susceptibility to this antimicrobial, which was significant only among coagulase-negative staphylococci. Resistance to ciprofloxacin is a strong marker of in vitro multiresistance and poor clinical outcome of peritonitis.

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Section: Discussionmentioning

confidence: 99%

Section: Treatment Of Peritonitis and Exit-site Infectionsmentioning

confidence: 99%

Treatment of Peritoneal Dialysis-Related Peritonitis with Ciprofloxacin Monotherapy: Clinical Outcomes and Bacterial Susceptibility over Two Decades

et al. 2009

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“…An interesting historic review on the use of fluoroquinolones in PD-related peritonitis was published by Janknegt in 1991 (20). Some studies show that ciprofloxacin is not effective in treating CAPD-and APD-related peritonitis (21)(22)(23); other studies have demonstrated that ciprofloxacin may be successful in this setting (18,(24)(25)(26)(27). Yeung et al (28) have shown that ciprofloxacin, given 750 mg orally every 12 hours to continuous cyclic PD patients, may be useful for empirical gram-negative coverage and for the treatment of documented peritonitis caused by sensitive E. coli or Klebsiella species.…”

Section: Discussionmentioning

confidence: 99%

Ciprofloxacin and Cefazolin as a Combination for Empirical Initial Therapy of Peritoneal Dialysis-Related Peritonitis: Five-year Follow-up

et al. 2007

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The treatment of peritoneal dialysis (PD)-related peritonitis has been a matter of extensive investigation, frequently generating therapeutic trials. Several combinations of antibiotics have served as newer protocols and tended to be efficacious, comfortable, and cost-effective. According to the more recent recommendations from the International Society for Peritoneal Dialysis, the rationale for empirical initial therapy of clinically detected peritonitis in PD patients has been to follow the bacterial profile derived from cultured specimens of PD effluents. The current study describes 5 year's experience with the use of a new antibiotic regimen for the treatment of peritonitis. We herein analyze the outcome of 95 episodes of peritonitis in 54 patients on either automated PD or continuous ambulatory PD at the dialysis unit of the Federal University of Rio de Janeiro. Peritoneal dialysis-related peritonitis was treated with the combination of oral ciprofloxacin and intraperitoneal cefazolin. The observed cure rate was 85.2% and the sensitivity test was observed to be positive for this combination of antibiotics in 88.9% of positive cultures. Of the 14 unsuccessful episodes, 7 were due to catheter colonization and the rest did not respond to the proposed therapy within 48 hours. These 7 cases were also related to peritoneal fluid cultures that were resistant to both ciprofloxacin and cefazolin. From this study, we propose this combination of oral ciprofloxacin and intraperitoneal cefazolin as a first choice for empirical initial therapy of PD-related peritonitis, given its efficacy and low cost. However, in order to apply the most adequate cost-effective therapy, careful examination of the bacterial profile and sensitivities to antibiotics used in each unit is strongly recommended.

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“…Studies with ciprofioxacin in chronic ambulatory peritoneal dialysis (CAPD) patients were mostly performed using intraperitoneally administered ciprofioxacin at a dose of 25 or 50mg/1 for each bag of dialysate for 5-7 days (LUDLAM et al 1990;DRYDEN et al 1991;PEREZ et al 1993). Cure rates for gram-negative infections were higher (95%) than for gram-positive infections (67%).…”

Section: Peritonitis In Chronic Ambulatory Dialysis Patientsmentioning

confidence: 99%

Quinolone Antibacterials

1998

Handbook of Experimental Pharmacology

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Low dose intraperitoneal ciprofloxacin for the treatment of peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD)

Cited by 10 publications

References 0 publications

Treatment of Peritoneal Dialysis-Related Peritonitis with Ciprofloxacin Monotherapy: Clinical Outcomes and Bacterial Susceptibility over Two Decades

Treatment of Peritoneal Dialysis-Related Peritonitis with Ciprofloxacin Monotherapy: Clinical Outcomes and Bacterial Susceptibility over Two Decades

Ciprofloxacin and Cefazolin as a Combination for Empirical Initial Therapy of Peritoneal Dialysis-Related Peritonitis: Five-year Follow-up

Quinolone Antibacterials

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