Poor response to oral ciprofloxacin in the treatment of peritonitis in patients on intermittent peritoneal dialysis.

ABSTRACT

OBJECTIVES: To assess the clinical value of oral ciprofloxacin in the treatment of peritonitis in an intermittent peritoneal dialysis (IPD) population. DESIGN: Open nonrandomized prospective study. SETTING: Nephrology Peritoneal Dialysis Unit in a tertiary care, teaching hospital of the University of Toronto. PATIENTS Subjects were participants of the IPD program with an acute episode of peritonitis defined as at least two of the following 1. signs and symptoms of peritonitis, 2. cloudy peritoneal fluid with a white blood cell count of > 100/microL, 3. demonstration of bacteria in peritoneal effluent by gram stain or culture. Ten patients were enrolled in the study, but two were withdrawn because of side effects and growth of a resistant bacteria. INTERVENTIONS: Ciprofloxacin 750 mg po q12h for 2 doses, then 750 mg daily or 500 mg twice daily for 10 days. MAIN OUTCOME MEASURES: Efficacy was determined by clinical and microbiological assessment. Cure was defined as resolution of signs and symptoms with eradication of the causative organism. Peritoneal effluent and blood samples were analyzed for ciprofloxacin concentration. RESULTS: Ciprofloxacin was effective in treating only one of ten episodes of peritonitis. Seven patients were defined as microbiological failures (persistence or relapse of organisms). The signs and symptoms of peritonitis improved in 2 patients, but the remaining 5 failed clinically. Only Gram-positive organisms were cultured. CONCLUSIONS: Ciprofloxacin cannot be recommended for the treatment of intermittent peritoneal dialysis-related Gram-positive bacterial peritonitis.