A RANDOMIZED PROSPECTIVE COMPARISON OF ORAL LEVOFLOXACIN PLUS INTRAPERITONEAL (IP) VANCOMYCIN AND IP NETROMYCIN PLUS IP VANCOMYCIN AS PRIMARY-TREATMENT OF PERITONITIS COMPLICATING CAPD

Objective:To compare the therapeutic efficacy of daily oral levofloxac in plus intermittent intraperitoneal (IP) vancomycin (group 1)versus d aily IP netromycin and intermittent IP vancomycin (group 2) in the pri mary treatment of peritonitis complicating continuous ambulatory perit oneal dialysis (CAPD). Design: A randomized multicenter prospective op en-label comparative clinical study. Setting: University and Hospital Authority hospitals in Hong Kong. Patients: All CAPD patients who deve loped bacterial or culture-negative peritonitis beyond 28 days of a pr evious episode and without evidence of septicemia, associated tunnel i nfection, or known sensitivity to trial medications were accepted into the clinical trial. Results: A total of 101 patients entered the tria l. The primary cure rate was 74.5% for group 1 and 73.6% for group 2. Baseline culture results appeared to influence the clinical outcome: t he primary cure rate for culture-negative, gram-positive, and gram-neg ative episodes was 83.3%, 78.6%, and 42.9% for group 1 and 69.1%, 76.9 %, and 71.3% for group 2, respectively. The primary cure rate also var ied considerably among individual centers and was particularly noticea ble in group 1. In the latter group, it correlated closely with in vit ro levofloxacin resistance which in turn correlated closely with previ ous exposure to fluoroquinolones. Conclusion: Oral levofloxacin in com bination with intermittent IP vancomycin has comparable efficacy to IP netromycin combined with intermittent IP vancomycin as primary treatm ent in CAPD peritonitis, but is simpler and more cost-effective to adm inister. It may be recommended as primary therapy in centers with rela tively low exposure and, therefore, low background resistance to fluor oquinolones.