Diagnosis, Prevention and Treatment of Peritonitis

Recent reports related to the diagnosis, prevention and treatment of peritonitis in patients on chronic peritoneal dialysis are reviewed. The reports deal with modifications of earlier drug therapies, the use of ultraviolet light, the use of the inline filter, and the biocompatibility of antibiotics in dialysis solutions.

Protein losses and tobramycin absorption in peritonitis treated by hourly peritoneal dialysis

The effects of peritonitis on dialysate protein losses of IgG, IgA, IgM, transferrin, and complement were investigated. Thirteen patients who developed peritonitis while undergoing peritoneal dialysis were compared with seven noninfected dialysis patients. Dialysate protein losses increased during peritonitis, but IgG, IgA, IgM, transferrin, and complement losses did not. The ratio of the amount of these proteins to the total amount of protein, measured by trichloroacetic acid precipitation, was unaltered by peritonitis, suggesting that albumin is the predominant protein lost during peritonitis. The infected patients absorbed 55% of the administered dose of tobramycin, at 17 mL/min, and the noninfected 44%, at 13 mL/min.

The pharmacokinetics of antibiotics used to treat peritoneal dialysis-associated peritonitis

Antibiotics continue to be used frequently to treat CAPD-associated peritonitis. Selection of appropriate antibiotic doses and routes of administration has been based largely upon clinical experience. Early pharmacokinetic studies utilized patients being treated with IPD. The relevance of these studies to CAPD remains unknown. Little information exists on the effects of peritonitis on peritoneal drug transport. Until the effects of peritonitis during CAPD are better understood, pharmacokinetic data will be of limited value in designing specific treatment recommendations for this common complication of peritoneal dialysis.