Treatment of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) with intraperitoneal cefazolin and gentamicin

Between 1983 and 1988 57 peritonitis episodes in an unselected patient population were initially treated with intraperitoneal cefazolin and gentamicin. The loading dose consisted of 500 mg cefazolin/L dialysate and 40 mg gentamicin/L dialysate. The maintenance dosage was 125 mg cefazolin and 8 mg gentamicin per liter dialysate. Forty-five (78.9%) patients were primarily cured with this regimen (responder group = RG). Twelve patients (21.1%) did not respond to the initial therapy (nonresponder group = NG). Eight peritonitis episodes in the NG (14.0% of all patients) were caused by tunnel infections and 2 by diverticulitis (3.5%). The cure rate in patients without tunnel infection or bowel disease was 95.7%. A relapse occurred in 2 patients (3.5%). Duration of therapy was assessed by daily white blood cell count (WBC) in the effluent and treatment was discontinued when the WBC was less than 100/microliters for 3 days. The mean duration of therapy with cefazolin and gentamicin was 8.1 days in the RG and 6.0 days in the NG. Nonresponders were subsequently treated with a modified antibiotic regimen on an average 11.9 days.