Coronel F, Herrero JA, Mateos P, Illescas ML, Barrientos A
Teicoplanin-cefotaxime vs. vancomycin-tobramycin as
initial treatment of peritonitis in peritoneal dialysis
17th Annual CAPD Conference
Perit Dial Int Suppl 1
(Feb) 17:S30 1997
In 1992-3, these investigators followed a standard vancomycin-tobramycin
protocol to treat peritonitis Then in 1994-6 they changed to teicoplanin-
cefotaxime, "because of an increasing incidence of relapsing peritonitis".
During the first period there were 28 peritonitis episodes (n of patients
unspecified, incidence 1:17 patient months), of which 22 were due to
Staphylococcus species. Twenty-two episodes of relapsing peritonitis (not
clearly defined) were registered during this vancomycin-tobramycin period.
The average time of "cloudy fluid" was 45 hours. During the second period,
(teicoplanin-cefotaxime) the incidence of peritonitis was similar (1:19
patient months). Of 26 episodes, Staph was found in 18, but there was only
one episode of relapsing peritonitis, and the time of "cloudy fluid" was
reduced to 33 hours. The authors conclude that use of T-C as empiric
initial therapy results in a lower incidence of relapsing peritonitis and
more rapid resolution of the initial inflammation (cloudy fluid).
Comment: This is a historic comparison. No treatment details are
given and there is no separation of S. aureus from other
staphylococci. There is no mention of exit site infection (the main cause
of relapse) . Use of average time of cloudy fluid is not justified since it
is a discontinuous observation (6 hours exchange). Teicoplanin is not
available in all parts of the world. It is better reserved for treatment
of vancomycin resistant enterococci.
(Stephen Vas, M.D., University of Toronto, Canada)
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17th Annual CAPD Conference
Basic peritoneal dialysis :
Peritonitis and exit-site infection