The efficacy of intraperitoneally administered gentamicin and rifampin as initial treatment of peritoneal dialysis-related peritonitis.

For the initial treatment of peritonitis complicating peritoneal dialysis (PD), we use intraperitoneally administered gentamicin (broad spectrum and low costs) and rifampin (intracellular bactericidal activity). In order to assess the efficacy of this treatment, the outcome of 248 suspected episodes of peritonitis (abdominal pain, cloudy effluent, and a leukocyte count over 100/mm3) was evaluated. Of 227 cases with a positive culture of the PD effluent, one bacterial species was cultured in 188 cases (75.8%), more than one in 32 cases (12.9%), and in 7 cases (2.8%) yeasts. In 87.2% of the culture-positive cases, a good clinical response to the initialized antibiotic therapy was found. In 20 cases (8.1%) antibiotic treatment was discontinued within one week because no micro-organisms were cultured. In one case no effluent was cultured. Although in vitro resistance or indifference to both antibiotics was found in 45 cases (19.8%), in only 29 culture-positive cases (12.8%) the clinical condition did not improve on initial therapy. Of the peritonitis episodes in which micro-organisms resistant to both antibiotics were cultured, 23 were Staphylococcus epidermidis, 5 were E. coli, 7 were yeasts, and there were miscellaneous (mostly enteral) bacteria in 10 cases. In the studied period no significant changes were found in the susceptibility of the cultured microorganisms to gentamicin and rifampin. Susceptibility profile per episode, however, showed an increasing resistance against both antibiotics. It is concluded that the combination of gentamicin and rifampin as initial treatment of peritonitis is effective in most (87%) cases.(ABSTRACT TRUNCATED AT 250 WORDS)