Intraperitoneal Antibiotics for Peritonitis

• 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:

1. Diagnosis and Treatment of Peritonitis in Peritoneal Dialysis Patients.  2010 Fresenius Medical Care North America
2. Antibiotic Therapy for Peritonitis Treatment Overview http://emedicine.medscape.com/article/1926162-overview
3. Intraperitoneal administration of drugs in peritoneal dylisis patients. http://www.pdiconnect.com/content/29/1/5.full