Effective treatment of peritoneal dialysis-associated peritonitis with cefazolin and ceftazidime in children

Objective: To evaluate the use of the combination of cefazolin and ceftazid ime for initial treatment of peritoneal dialysis (PD)-related peritonitis i n pediatric patients. Design: Retrospective nonrandomized study. Setting: Pediatric dialysis units of the University Medical Center of Utrec ht and Nijmegen, The Netherlands. Patients: 40 children (median age 5.4 years) who were treated with PD durin g the study period of 4.5 years. Interventions: All 50 episodes of peritonitis that occurred during the stud y period were evaluated by review of medical records. Patients were given i ntraperitoneal ceftazidime 500 mg/L dialysis fluid, and cefazolin 500 mg/L as a loading dose, followed by a maintenance dose of ceftazidime 125 mg/L a nd cefazolin 100 mg/L, intraperitoneally, 4 times daily. Antibiotics were c ontinued for 14 days. Results: After identification of the causative microorganism, one of the an tibiotics was discontinued in 34 cases, and the antibiotic schedule was ada pted in 2 cases. All cases were initially cured within 3 days. In 5 cases ( 10%), there was a peritonitis with the same organism recurring within 2 wee ks after completion of treatment. There were 4 cases of PD-related peritoni tis caused by pseudomonas, all of which were cured. Conclusions: The antibiotic combination of cefazolin and ceftazidime is eff ective for the initial therapy of PD-related peritonitis in children. The t oxic complications of aminoglycosides are avoided with this combination.