Further Experience with Two Intraperitoneal Vancomycin Loading Doses for Treatment of Gram-positive or Sterile Peritonitis in CAPD Patients

We present a new protocol for treatment of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. In this protocol, episodes of gram-positive or “sterile” peritonitis are treated with two intraperitoneal (i.p.) doses of vancomycin (30 mg{kg with 6 h of i.p. dwell) which are given one week apart. Patients whose initial peritoneal fluid Gram stain does not reveal any organisms receive an intramuscular (i.m.) loading dose of tobramycin or gentamycin in addition, until the culture result becomes available at 48 h. Those with a negative peritoneal fluid culture (“sterile” peritonitis) receive maintenance i.p. gentamycine or tobramycin. We report our experience with 24 episodes of gram-positive or “sterile” peritonitis. Except for 1 of the 24 episodes that was followed with two successive relapses, all the other episodes responded well (cure rate of 96%). In only 15% of the instances patients were hospitalized to be assisted with their CAPD exchanges. We conclude this new approach remarkably simplifies treatment of peritonitis in CAPD patients, and based on our preliminary results it seems to be as effective, if not superior to, the currently employed treatment protocols. Further studies with this therapeutic regime with careful audiometric evaluation of those who receive both vancomycin and aminoglycoside are necessary in future.