Lui Sing Leung, Cheng Suk Wai, Ng Flora, Ng Suk Yi, Wan Kit Mui, Yip Terence, Tse Kai Chung, Lam Man Fai, Lai Kar Neng, Lo Wai Kei
Division of Nephrology, University Department of Medicine, Tung Wah Hospital, Hong Kong SAR, People's Republic of China.
Kidney Int. 2005 Nov;68(5):2375-80. doi: 10.1111/j.1523-1755.2005.00700.x.
BACKGROUND. The International Society for Peritoneal Dialysis (ISPD) treatment guidelines for continuous ambulatory peritoneal dialysis (CAPD) peritonitis 2000 recommended the use of cefazolin plus ceftazidime as the initial empirical therapy in patients with residual renal function (RRF). However, this treatment regimen has not been compared with the conventional regimen of cefazolin plus netilmicin in prospective, randomized controlled trials.
Stable CAPD patients who developed clinical evidence of peritonitis were randomized to receive intraperitoneal (i.p.) cefazolin plus netilmicin or cefazolin plus ceftazidime once daily in the long dwell for 14 days. For patients with RRF (>1 mL/minute) before entry into the study (N= 50), RRF and 24-hour urine volume were measured at days 1, 14, and 42 after commencement of i.p. antibiotic treatment.
One hundred and two patients were recruited into the study. The primary cure rates of i.p. cefazolin plus netilmicin and cefazolin plus ceftazidime were 66.7% and 64.7%, respectively. The overall cure rate for the 2 treatment regimens was 82.3% for both. Seven patients (14%) from each treatment group required removal of the dialysis catheters due to treatment failure. Relapse of peritonitis occurred in 2 patients (4%) in both treatment groups. Thirty-six patients with RRF at baseline achieved primary cure of their peritonitis by the assigned antibiotics. In this subgroup of patients, their RRF and daily urine volume showed significant reduction at day 14 and returned to near baseline values at day 42. The degree of reduction in RRF and urine volume did not differ significantly between the patients treated with cefazolin plus netilmicin and cefazolin plus ceftazidime.
Intraperitoneal cefazolin plus netilmicin and cefazolin plus ceftazidime have similar efficacy as empirical treatment for CAPD peritonitis. In CAPD patients with RRF, significant but reversible reduction in RRF and 24-hour urine volume could occur after an episode of peritonitis, despite successful treatment by i.p. antibiotics. The effect of i.p. cefazolin plus netilmicin, or i.p. cefazolin plus ceftazidime on RRF in CAPD patients with peritonitis does not appear to be different. Our findings do not support the routine use of cefazolin and ceftazidime as the empirical treatment for CAPD peritonitis.
背景。国际腹膜透析学会（ISPD）2000年持续性非卧床腹膜透析（CAPD）腹膜炎治疗指南推荐，对于仍有残余肾功能（RRF）的患者，初始经验性治疗采用头孢唑林加头孢他啶。然而，在前瞻性随机对照试验中，该治疗方案尚未与头孢唑林加奈替米星的传统方案进行比较。
发生腹膜炎临床证据的稳定CAPD患者被随机分组，一组接受腹腔内（i.p.）头孢唑林加奈替米星，另一组接受头孢唑林加头孢他啶，均每日一次在长留置液中给药，持续14天。对于入组前RRF>1 mL/分钟的患者（N = 50），在腹腔内抗生素治疗开始后的第1、14和42天测量RRF和24小时尿量。
102例患者被纳入研究。腹腔内头孢唑林加奈替米星和头孢唑林加头孢他啶的主要治愈率分别为66.7%和64.7%。两种治疗方案的总体治愈率均为82.3%。每个治疗组有7例患者（14%）因治疗失败需要拔除透析导管。两个治疗组均有2例患者（4%）发生腹膜炎复发。36例基线时有RRF的患者通过指定的抗生素实现了腹膜炎的初步治愈。在该亚组患者中，他们的RRF和每日尿量在第14天显著降低，并在第42天恢复到接近基线值。接受头孢唑林加奈替米星治疗的患者与接受头孢唑林加头孢他啶治疗的患者相比，RRF和尿量的降低程度无显著差异。
腹腔内头孢唑林加奈替米星和头孢唑林加头孢他啶作为CAPD腹膜炎的经验性治疗具有相似的疗效。在有RRF的CAPD患者中，尽管腹腔内抗生素治疗成功，但腹膜炎发作后RRF和24小时尿量可能会出现显著但可逆的降低。腹腔内头孢唑林加奈替米星或腹腔内头孢唑林加头孢他啶对有腹膜炎的CAPD患者RRF的影响似乎没有差异。我们的研究结果不支持常规使用头孢唑林和头孢他啶作为CAPD腹膜炎的经验性治疗。
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