Initial treatment of peritoneal dialysis peritonitis without vancomycin with a once-daily cefazolin-based regimen

To reduce the use of vancomycin, the current recommendations of the Interna tional Society of Peritoneal Dialysis (PD) for the initial treatment of per itonitis complicating PD are to administer intraperitoneal (IP) cefazolin o r cephalothin in every PD fluid bag, together with once-daily gentamicin. I n view of the inherent impracticalities of this regimen, we studied the eff icacy of once-daily cefazolin (1.5 g) IP with gentamicin IP as initial trea tment for primary (nonrecurrent) PD peritonitis. This regimen has been used in all episodes of peritonitis not associated with tunnel or exit-site inf ections or fluid leaks. Sixty-nine episodes in 61 patients were analyzed (4 4 patients, continuous ambulatory PD; 22 patients, automated PD; and 3 pati ents, hospital-based intermittent PD), of which 38 episodes (55%) were gram -positive infections, 6 episodes (9%) were gram-negative infections, and 18 episodes (26%) had negative culture results. Four patients died within 4 w eeks of infection (none considered attributable to inadequate treatment of their peritonitis). Ten catheters (14.5%) required removal to clear the inf ection; 7 catheters were in patients with gram-negative infections. The rel apse rate within 4 weeks of ceasing antibiotic therapy was 8.9%. Compared w ith the results of 40 episodes of peritonitis treated initially with our pr evious IP vancomycin and gentamicin regimen, successful treatment (no death , catheter removal, or recurrence) was achieved in 52 of 69 episodes in the cefazolin group (75.4%) versus 23 of 40 episodes in the vancomycin group ( 57.5%; P = 0.058). In conclusion, once-daily IP cefazolin and gentamicin fo r the initial treatment of PD peritonitis is at least as effective as a Van comycin-based regimen and is well tolerated. (C) 2001 by the National Kidne y Foundation, Inc.