Nystatin prophylaxis: Its inability to prevent fungal peritonitis patientson continuous ambulatory peritoneal dialysis

Objective:To evaluate the potential effectiveness of nystatin as prophylaxi s for fungal peritonitis (FP) in patients on continuous ambulatory peritone al dialysis (CAPD). Design: This historically controlled study was designed to investigate the effectiveness of nystatin in the prevention of FP. For this purpose we comp ared the incidence of FP among 240 (new and prevalent) CAPD patients betwee n January 1996 and November 1996 (period A) with its incidence in 240 new a nd prevalent CAPD patients in our program between January 1997 and November 1997 (period B) when nystatin prophylaxis was used. There were 2400 patien t-months in each period. Nystatin (500 000 IU four times per day), was give n orally at the beginning of other antibiotic therapy (usually for peritoni tis) and continued for 5 days after the end of the antibiotic therapy. Results: During period A, 133 peritonitis episodes were recorded, and durin g period B, 99 episodes were recorded. Six episodes of FP were identified i n over 2400 patient-months of period A, and 12 in over 2400 patient-months of period B. This difference was not statistically significant. Three episo des of antibiotic-related FP were seen in period A, and four in period B. T he remaining episodes arose de novo, that is, unrelated to the use of antib iotics. We observed no side effects for nystatin. Conclusion: In CAPD patients the use of nystatin, a nonabsorbable antifunga l agent, as prophylaxis in every instance of peritonitis or other indicatio ns for antibiotics, did not lower the incidence of fungal peritonitis.