HDCN Article Review/Hyperlink

Lo W-K, Chan C-Y, Cheng S-W, Poon JF-M, Chan DT-M, Cheng IK-P

A prospective randomized control study of oral nystatin prophylaxis for Candida peritonitis complicating continuous ambulatory peritoneal dialysis

Am J Kidney Dis (Oct) 28:549-552 1996

Fungal peritonitis is a rare but important cause of morbidity and mortality in CAPD patients and generally requires removal of the PD catheter. The major risk factor is antibiotic therapy. All patients receiving CAPD at two dialysis centers over a two-year period were randomized to receive either oral nystatin tablets 500,000 units four times daily (Group 1, n=199) or no nystatin (Group 2, n=198) whenever antibiotic therapy was required. The duration of nystatin was the same as the antibiotic therapy except that it lasted 3 additional days after the last dose of aminoglycosides and 7 additional days after the last dose of vancomycin.

Rates of peritonitis and antibiotic administration were 1/16.6 mo. and 1/17.5 mo. in Groups 1 and 2, respectively (p = NS). The risk of developing candida peritonitis was significantly higher in group 2 (12 episodes in 11 patients) than in Group 1 (4 episodes in 4 patients). However antibiotic-related candida peritonitis, defined as candida peritonitis developing within 3 months after receiving antibiotics, was not significantly different between the groups (3 episodes in Group 1 vs. 6 episodes in Group 2). The authors conclude that oral nystatin prophylaxis is effective in reducing the incidence of candida peritonitis in CAPD patients.

Comment: This is a well-done randomized controlled trial. The fact that nystatin did not decrease antibiotic-related peritonitis may be a beta error due to insufficient number of episodes. A larger group of patients or a meta-analysis would be necessary to exclude this possibility. (David J. Leehey, M.D., Loyola University at Chicago)