Brauner L, Kahlmeter G, Lindholm T, Simonsen O
J Antimicrob Chemother. 1985 Jun;15(6):751-8. doi: 10.1093/jac/15.6.751.
The first line treatment of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) in our hospital was recently altered from a combination of gentamicin and clindamycin, given as continuous peritoneal lavage, to one of vancomycin and netilmicin given in peritoneal dialysis fluid with prolonged dwell time (4-6 h). The change was prompted by the emergence of multiply resistant Staphylococcus epidermidis among CAPD patients and nursing staff. In 9 of 19 episodes of peritonitis treated with gentamicin/clindamycin, the infecting organism could still be isolated from peritoneal fluid 5-15 days after commencement of therapy. All of 35 culture verified episodes treated with vancomycin/netilmicin were cleared bacteriologically within 3 days (P less than 0.0005). The vancomycin and netilmicin serum levels achieved were 6.5-37.0 mg/l and 1.0-8.1 mg/l, respectively. Apart from an asthmatic reaction, possibly triggered by vancomycin, no side effects were seen. However, audiometry was not performed regularly and the possible effect of netilmicin on the residual renal function was not systematically investigated.
我院持续性非卧床腹膜透析（CAPD）患者腹膜炎的一线治疗方案最近发生了改变，从持续腹膜灌洗使用庆大霉素和克林霉素联合用药，改为在腹膜透析液中使用万古霉素和奈替米星且延长留腹时间（4 - 6小时）。这一改变是由于CAPD患者及护理人员中出现了多重耐药的表皮葡萄球菌。在用庆大霉素/克林霉素治疗的19例腹膜炎病例中，有9例在治疗开始后5 - 15天仍能从腹透液中分离出感染病原体。在用万古霉素/奈替米星治疗的35例经培养证实的病例中，所有病例在3天内细菌学清除（P小于0.0005）。所达到的万古霉素和奈替米星血清水平分别为6.5 - 37.0毫克/升和1.0 - 8.1毫克/升。除了可能由万古霉素引发的哮喘反应外，未观察到其他副作用。然而，未定期进行听力测定，且未系统研究奈替米星对残余肾功能的可能影响。
