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Article: A randomized prospective comparison of oral versus intraperitoneal ofloxacin as the primary treatment of CADP peritonitis

TitleA randomized prospective comparison of oral versus intraperitoneal ofloxacin as the primary treatment of CADP peritonitis
Authors
KeywordsContinuous Ambulatory Peritoneal Dialysis
Ofloxacin
Peritonitis
Issue Date1997
PublisherBlackwell Publishing Asia. The Journal's web site is located at http://www.blackwellpublishing.com/journals/NEP
Citation
Nephrology, 1997, v. 3 n. 5, p. 431-435 How to Cite?
AbstractOral ofloxacin has been successfully used in our centres for the primary treatment of peritonitis complicating continous ambulatory peritoneal dialysis (CAPD). In view of the progressive rise in the resistance rate to ofloxacin among peritoneal bacterial isolates, a study was conducted to determine if oral ofloxacin remains a viable first line treatment for CAPD peritonitis in our centres and if the result can be improved by changing from an oral to an intraperitoneal (i.p.) route. In patients on three 2 L daily CAPD exchanges, ofloxacin given at the i.p. dosage of 200 mg loading followed by 25 mg/L of peritoneal dialysate achieved overnight trough peritoneal levels which are at least four times the minimal 90% inhibitory concentration (MIC90) of most bacterial pathogens without significant accumulation in the systemic circulation. This i.p. dosage was therefore chosen for the clinical study and the result was compared to that using ofloxacin given in the oral dosage of 400 mg 1oading followed by 300 mg once daily as maintenance. Of all the recruited episodes, 35 were eligible for analysis. The overall primary cure rate including primary failures and relapses was 55.6% (10/18) in the oral treatment group and 70.6% (12/17) in the i.p. treatment group. The corresponding figures for gram positive bacterial (g +) infections were 36.4% and 50%, for gram negative bacterial (g-) infections were 66.7 and 80% and for culture negative infections were 75 and 80%. In culture positive cases, all treatment failures were due to resistant infections which were observed in 42.3% of all bacterial isolates, 47.1% of g+ isolates and 33.3% of g- isolates. Due to the high background level of bacterial resistance among our CAPD population, ofloxacin monotherapy given either by the oral or the i.p. route can no longer be recommended for the primary treatment of CAPD peritonitis.
Persistent Identifierhttp://hdl.handle.net/10722/163522
ISSN
2015 Impact Factor: 1.796
2015 SCImago Journal Rankings: 0.894
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorCheng, IKPen_US
dc.contributor.authorLui, SLen_US
dc.contributor.authorFang, GXen_US
dc.contributor.authorChau, PYen_US
dc.contributor.authorCheng, SWen_US
dc.contributor.authorChiu, FHen_US
dc.contributor.authorChan, TMen_US
dc.contributor.authorLo, WKen_US
dc.contributor.authorChoy, BYen_US
dc.contributor.authorLo, CYen_US
dc.date.accessioned2012-09-05T05:33:05Z-
dc.date.available2012-09-05T05:33:05Z-
dc.date.issued1997en_US
dc.identifier.citationNephrology, 1997, v. 3 n. 5, p. 431-435en_US
dc.identifier.issn1320-5358en_US
dc.identifier.urihttp://hdl.handle.net/10722/163522-
dc.description.abstractOral ofloxacin has been successfully used in our centres for the primary treatment of peritonitis complicating continous ambulatory peritoneal dialysis (CAPD). In view of the progressive rise in the resistance rate to ofloxacin among peritoneal bacterial isolates, a study was conducted to determine if oral ofloxacin remains a viable first line treatment for CAPD peritonitis in our centres and if the result can be improved by changing from an oral to an intraperitoneal (i.p.) route. In patients on three 2 L daily CAPD exchanges, ofloxacin given at the i.p. dosage of 200 mg loading followed by 25 mg/L of peritoneal dialysate achieved overnight trough peritoneal levels which are at least four times the minimal 90% inhibitory concentration (MIC90) of most bacterial pathogens without significant accumulation in the systemic circulation. This i.p. dosage was therefore chosen for the clinical study and the result was compared to that using ofloxacin given in the oral dosage of 400 mg 1oading followed by 300 mg once daily as maintenance. Of all the recruited episodes, 35 were eligible for analysis. The overall primary cure rate including primary failures and relapses was 55.6% (10/18) in the oral treatment group and 70.6% (12/17) in the i.p. treatment group. The corresponding figures for gram positive bacterial (g +) infections were 36.4% and 50%, for gram negative bacterial (g-) infections were 66.7 and 80% and for culture negative infections were 75 and 80%. In culture positive cases, all treatment failures were due to resistant infections which were observed in 42.3% of all bacterial isolates, 47.1% of g+ isolates and 33.3% of g- isolates. Due to the high background level of bacterial resistance among our CAPD population, ofloxacin monotherapy given either by the oral or the i.p. route can no longer be recommended for the primary treatment of CAPD peritonitis.en_US
dc.languageengen_US
dc.publisherBlackwell Publishing Asia. The Journal's web site is located at http://www.blackwellpublishing.com/journals/NEPen_US
dc.relation.ispartofNephrologyen_US
dc.subjectContinuous Ambulatory Peritoneal Dialysisen_US
dc.subjectOfloxacinen_US
dc.subjectPeritonitisen_US
dc.titleA randomized prospective comparison of oral versus intraperitoneal ofloxacin as the primary treatment of CADP peritonitisen_US
dc.typeArticleen_US
dc.identifier.emailChan, TM:dtmchan@hku.hken_US
dc.identifier.authorityChan, TM=rp00394en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1111/j.1440-1797.1997.tb00266.x-
dc.identifier.scopuseid_2-s2.0-9844244023en_US
dc.identifier.hkuros31498-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-9844244023&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume3en_US
dc.identifier.issue5en_US
dc.identifier.spage431en_US
dc.identifier.epage435en_US
dc.identifier.isiWOS:A1997YD18500006-
dc.publisher.placeAustraliaen_US
dc.identifier.scopusauthoridCheng, IKP=7102537483en_US
dc.identifier.scopusauthoridLui, SL=7102379130en_US
dc.identifier.scopusauthoridFang, GX=55040637400en_US
dc.identifier.scopusauthoridChau, PY=36509704300en_US
dc.identifier.scopusauthoridCheng, SW=55259131600en_US
dc.identifier.scopusauthoridChiu, FH=7005502713en_US
dc.identifier.scopusauthoridChan, TM=7402687700en_US
dc.identifier.scopusauthoridLo, WK=7201502414en_US
dc.identifier.scopusauthoridChoy, BY=7003465499en_US
dc.identifier.scopusauthoridLo, CY=7401771743en_US

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