Mulhern JG, Dong VM, DelBuono JA, Bourgeault RG, Madden RL,
et al
Oral fluconazole therapy for the prevention of fungal
peritonitis in PD patients
XVIth Annual CAPD Conference
Perit Dial Int Suppl 2
(Feb) 16:S42 1996
The authors describe their experience with prophylactic antifungal drugs
given during therapy of
presumed bacterial peritonitis in an attempt to prevent the subsequent
development of fungal
peritonitis. Initially clotrimazole (10 mg po TID) was given in an attempt to
prevent fungal
colonization of the intestinal tract. Compliance with this multiple dosing
regimen, however, was
not good. For this reason, fluconazole, using an alternate day dosing
regimen, was substituted in
1994.
Of 24 peritonitis episodes treated with antibiotics plus qod fluconazole, 2
cases of subsequent
fungal peritonitis occurred, both with Torulopsis glabrata. Fungal
peritonitis with this
organism had not been previously encountered in this unit. T.
glabrata is resistant to all
azole antifungal agents. As a result of this adverse experience, the
investigators discontinued
routine antifungal prophylaxis with fluconazole during treatment of
peritonitis at their center.
Comment: This is a very important observation. Because treatment of
bacterial peritonitis
almost invariably precedes fungal peritonitis, the desirability of
concomitant anti-fungal
prophylaxis always emerges in discussions of this topic. While this study
does not completely
invalidate the ocncept of anti-fungal prophylaxis, it raises an important
caution flag and calls
attention to the need of carefully controlled randomized evaluation in this
area.
(Stephen I. Vas, M.D.)
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XVIth Annual CAPD Conference
Basic peritoneal dialysis :
Peritonitis and exit-site infection