A randomized prospective comparison of intraperitoneal cefazolin plus netilimicin versis cefazolin plus ceftazidime in the treatment of CAPD peritonitis

Abstract

BACKGROUND: The ISPD guidelines for the treatment of CAPD peritonitis 2000 recommended the use of cefazolin plus ceftazidime (C + C) as the initial empiric treatment. However, this regime has not been compared with the conventional regime of cefazolin plus netilmicin (C + N) in prospective randomized trials. AIM: To compare the efficacy of intraperitoneal (i.p.) C + N versus C + C in the treatment of peritonitis complicating CAPD. METHODS: This is a prospective randomized open-label study. CAPD patients who developed clinical evidence of peritonitis were randomized to receive either i.p. C + Nor i.p. C + C, given once daily in the long dwell. The duration of treatment was 14 days. Patients who failed to respond to the assigned antibiotics were allowed to switch antibiotics according to the peritoneal fluid bacterial culture results. RESULTS: One hundred stable CAPD patients were recruited into the study. The mean age of the patients was 65 ± 13.4 years (range: 26–90). The mean duration of CAPD was 45.3 ± 47.5 months (range: 1–240). Forty-nine patients were randomized to receive C + N while 51 patients were randomized to receive C + C The culture positive rate for the C + Nand the C + C groups was 79.6% and 76.5% respectively. The primary response rate to the assigned antibiotic regimes for the C + N and the C + C groups was 63.2% and 64.7% respectively (P = NS). The overall cure rate for the two treatment groups was 81.6% and 82.3% respectively (P = NS). Seven patients from each of the two treatment groups failed to respond to i.p. antibiotic treatment and required removal of their peritoneal dialysis catheters. Relapse of CAPD peritonitis occurred in two patients from both treatment groups. CONCLUSIONS: We conclude that C + N and C + C have similar efficacy in the treatment of peritonitis complicating CAPD.