- Bacterial infections come from contamination during peritoneal dialysis and fungal infections may occur subsequent to antibiotic use
- clinical presentation consistent with cloudy effluent and abdominal pain, which can range from mild to severe.
- The severity of pain can be related to specific organisms (e.g., mild pain with CoNS and severe pain with gram-negative rods, streptococcus, and S. aureus)
- peritonitis is deemed the probable cause if effluent cell count with differential should be obtained, and if after 2 hours of dwell time, the WBC is greater than 100/µL with a minimum of half being polymorphonuclear neutrophilic cells and inflammation is present
Intraperitoneal (IP)
- IP dosing is favored over intravenous (IV) dosing because the local levels that can be achieved are higher with IP.
- Additionally, IP route is advantageous because the patient can perform it at home after adequate training.
- It also avoids venipuncture necessary for IV access.
- antibiotic must dwell for a minimum of 6 hours to ensure adequate absorption
Empiric Antibiotic Treatment
Gram (+)
Gram (-)
Dosing and Stability
References:
- Diagnosis and Treatment of Peritonitis in Peritoneal Dialysis Patients. 2010 Fresenius Medical Care North America
- Antibiotic Therapy for Peritonitis Treatment Overview http://emedicine.medscape.com/article/1926162-overview
- Intraperitoneal administration of drugs in peritoneal dylisis patients. http://www.pdiconnect.com/content/29/1/5.full
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