ORAL VERSUS INTRAPERITONEAL APPLICATION OF CLINDAMYCIN IN TUNNEL INFECTIONS - A PROSPECTIVE, RANDOMIZED STUDY IN CAPD PATIENTS

Objective.-To evaluate the potential superiority of either oral or int raperitoneal treatment of catheter tunnel infections (TI), using clind amycin as a first-line antibiotic and ultrasound as a diagnostic tool. Design: This was a prospective, randomized study in continuous ambula tory peritoneal dialysis patients. From August 1993 until August 1995, 16 clinically-and ultrasound-proven episodes of TI were randomly assi gned to either an oral or an intraperitoneal (IF) treatment (100 patie nts, 1414 patient-months). Main criteria for TI diagnosis were purulen t drainage from the exit site and/or a positive ultrasound (pericathet er fluid collection of at least 2 mm, 7.5 MHz transducer). initially, clindamycin (20 mg/kg body weight) was given via the oral (three times per day) or intraperitoneal route (four times per day). In the case o f incompatibility or resistance to clindamycin, either oxacillin or ci profloxacin were used orally or IF. Results: Based on ultrasound crite ria, the mean time until a greater than or equal to 50% reduction of p ericatheter abscess diameter was 26 days (median) (range: 8 - 28 days) in the oral, and 15 days (8 - 27 days) in the IP group (p less than o r equal to 0.05). Showing no significant difference of pericatheter fl uid at study entry with 4 mm (median) (range: 2 - 6 mm) in the oral gr oup and 4 mm (2 - 4 mm) in the IP group, the IP treatment resulted in a decrease to 0 mm (0 - 2 mm) after 28 days (p < 0.05), while the diam eter was still 2 mm (0 - 10 mm) (NS) in the oral group. Disappearance of exit-site infection was also somewhat earlier in the intraperitonea l group (51 vs 15 days, NS). Catheter removal had to be done once in t he IP group and twice in the oral group within 6 months after study en try. Conclusions: The results give evidence for greater efficacy of th e IP application of clindamycin as a first-line antibiotic compared to the oral route for the treatment of tunnel infections.