Alves FR, Dantas RC
Is the treatment of beta-lactam-sensitive infections without
vancomycin possible?
17th Annual CAPD Conference
Perit Dial Int Suppl 1
(Feb) 17:S27 1997
The new peritonitis recommendations favor initial therapy with a
cephalosporin rather than vancomycin. A reasonable question is: what
percentage of Gram positive infections would be cured by
cephalosporins vs. vancomycin?
Alves et al retrospectively surveyed their experience with 118 episodes of
Gram positive infections in 85 patients. They treated their cases either
with vancomycin or with cephalosporin together with an aminoglycoside (dose
and length of treatment not given). In cases of treatment failure
(definition?) they switched to the other antibiotic. Their cephalosporin
sensitivity of S. aureus was 90% and cephalosporin sensitivity of
other Gram positives 100% (unlikely).
For initial treatment, the cure rate of S. aureus with vancomycin
was 76%, vs. only 38% with cephalosporins (extremely low). Initial
treatment cure rate with other Gram positive infections was similar: 77%
with vancomycin vs. 59% with cephalosporin.
The authors attribute the low overall cure rate to a high incidence of
concomitant S. aureus exit site infection. They conclude that,
despite high in vitro sensitivity to cephalosporins, the initial cure rate
with vancomycin is much higher than with cephalosporin, and question the
appropriateness of cephalosporin as initial therapy for Gram positive
peritonitis.
Comment: The selection criteria are not given in the abstract, nor
are treatment details. The percentage of exit site infection is not
given,
nor do we have details about outcome. In their present form, then, the
results do not prove anything.
(Stephen Vas, M.D., University of Toronto, Canada)
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17th Annual CAPD Conference
Basic peritoneal dialysis :
Peritonitis and exit-site infection