Once-daily intraperitoneal cefazolin and oral ciprofloxacin as empiric therapy for the treatment of peritonitis

The Ad Hoc Advisory Committee on Peritonitis Management has recommended intraperitoneal (IP) cefazolin and an aminoglycoside as empiric therapy for the treatment of peritonitis. Because most of our patients are on continuous cycler therapy, we developed a strategy of once-daily IP cefazolin and or al ciprofloxacin as empiric therapy All patients in our unit that developed peritonitis were given a once-daily 2 g load of IP cefazolin, plus 500 mg ciprofloxacin orally, twice daily. Ciprofloxacin was given two hours after any, phosphate binder or iron supplement. The IP cefazolin was allowed to dwell for at least 5h hours. The dialysate was then drained and chronic peritoneal dialysis (CPD) resumed. Organisms sensitive to cefazolin were treated for 14 days with once-daily cefazolin alone, resistant organisms, were treated with alternative antibiotics. A total of 40 patients were treated with this empiric regimen, of these, 35 (88%) successfully continued CPD therapy, 1 (2%) transferred to hemodialysis, and 4 (10%) expired two weeks after the onset of peritonitis. A total of 22 patients (55%) were treated successfully with once-daily IP cefazolin. Although once-daily IP cefazolin and oral ciprofloxacin permitted continuation of CPD therapy in most patients in this study the therapy was not optimal. While vancomycin may have provided better coverage, recent reports of vancomycin-resistant enterococci and Staphylococcus aureus present a major concern.