Lo W K, Chan C Y, Cheng S W, Poon J F, Chan D T, Cheng I K
Department of Medicine, Tung Wah Hospital, Hong Kong.
Am J Kidney Dis. 1996 Oct;28(4):549-52. doi: 10.1016/s0272-6386(96)90466-7.
A prospective randomized study of the prevention of candida peritonitis (CP) in continuous ambulatory peritoneal dialysis patients using oral nystatin given concomitantly with antibiotic therapy was carried out for 2 years. Patients were randomized into two groups. Nystatin tablets 500,000 units four times a day were given to group 1 but not group 2 patients whenever antibiotics were prescribed. There were 199 patients at risk (mean follow-up, 18.0 months) in group 1 and 198 patients at risk (mean follow-up, 16.6 months) in group 2. The peritonitis and antibiotic prescription rates were comparable between the two groups. There were four episodes of CP in four patients in group 1 and 12 episodes in 11 patients in group 2. The probability of CP-free survival at 2 years was higher in group 1 compared with group 2 (0.974 v 0.915; P < 0.05). However, only three (75%) CP episodes in group 1 and six (50%) in group 2 were considered "antibiotics related." The incidence of antibiotics-related CP was 1.39 and 3.19 per 100 peritonitis episodes and 0.66 and 1.43 per 100 antibiotic prescriptions in groups 1 and 2, respectively (P = NS). We conclude that oral nystatin prophylaxis with each antibiotic prescription reduced the rate of CP in patients on continuous ambulatory peritoneal dialysis irrespective of its apparent temporal relationship to antibiotic prescription.
一项前瞻性随机研究对持续非卧床腹膜透析患者在使用抗生素治疗的同时口服制霉菌素预防念珠菌性腹膜炎（CP）进行了2年。患者被随机分为两组。每当给患者开抗生素时，第1组患者给予制霉菌素片50万单位，每日4次，而第2组患者不给予。第1组有199例有风险的患者（平均随访18.0个月），第2组有198例有风险的患者（平均随访16.6个月）。两组的腹膜炎和抗生素处方率相当。第1组4例患者发生4次CP发作，第2组11例患者发生12次发作。第1组2年无CP生存的概率高于第2组（0.974对0.915；P<0.05）。然而，第1组仅3次（75%）CP发作和第2组6次（50%）发作被认为“与抗生素相关”。第1组和第2组与抗生素相关的CP发生率分别为每100次腹膜炎发作1.39次和3.19次以及每100次抗生素处方0.66次和1.43次（P=无显著性差异）。我们得出结论，每次开抗生素时口服制霉菌素预防可降低持续非卧床腹膜透析患者的CP发生率，而不论其与抗生素处方之间明显的时间关系如何。
