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Review
. 2014 Apr 26;2014(4):CD005284.
doi: 10.1002/14651858.CD005284.pub3.

Treatment for peritoneal dialysis-associated peritonitis

Angela E Ballinger  1 , Suetonia C Palmer, Kathryn J Wiggins, Jonathan C Craig, David W Johnson, Nicholas B Cross, Giovanni F M Strippoli
Affiliations
Review

Treatment for peritoneal dialysis-associated peritonitis

Angela E Ballinger et al. Cochrane Database Syst Rev. .

Abstract

Background: Peritonitis is a common complication of peritoneal dialysis (PD) that is associated with significant morbidity including death, hospitalisation, and need to change from PD to haemodialysis. Treatment is aimed to reduce morbidity and recurrence. This is an update of a review first published in 2008.

Objectives: To evaluate the benefits and harms of treatments for PD-associated peritonitis.

Search methods: For this review update we searched the Cochrane Renal Group's Specialised Register to March 2014 through contact with the Trials Search Co-ordinator using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE and EMBASE, and handsearching conference proceedings.

Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs assessing the treatment of peritonitis in PD patients (adults and children). We included any study that evaluated: administration of an antibiotic by different routes (e.g. oral, intraperitoneal (IP), intravenous (IV)); dose of an antibiotic agent; different schedules of administration of antimicrobial agents; comparisons of different regimens of antimicrobial agents; any other intervention including fibrinolytic agents, peritoneal lavage and early catheter removal.

Data collection and analysis: Multiple authors independently extracted data on study risk of bias and outcomes. Statistical analyses were performed using the random effects model. We expressed summarised treatment estimates as a risk ratio (RR) with 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) with 95% CI for continuous outcomes.

Main results: We identified 42 eligible studies in 2433 participants: antimicrobial agents (36 studies); urokinase (4 studies), peritoneal lavage (1 study), and IP immunoglobulin (1 study). We did not identify any optimal antibiotic agent or combination of agents. IP glycopeptides (vancomycin or teicoplanin) had uncertain effects on primary treatment response, relapse rates, and need for catheter removal compared to first generation cephalosporins, although glycopeptide regimens were more likely to achieve a complete cure (3 studies, 370 episodes: RR 1.66, 95% CI 1.01 to 2.72). For relapsing or persistent peritonitis, simultaneous catheter removal and replacement was better than urokinase at reducing treatment failure rates (RR 2.35, 95% CI 1.13 to 4.91) although evidence was limited to a single small study. Continuous and intermittent IP antibiotic dosing schedules had similar treatment failure and relapse rates. IP antibiotics were superior to IV antibiotics in reducing treatment failure in one small study (RR 3.52, 95% CI 1.26 to 9.81). Longer duration treatment (21 days of IV vancomycin and IP gentamicin) had uncertain effects on risk of treatment relapse compared with 10 days treatment (1 study, 49 patients: RR 1.56, 95% CI 0.60 to 3.95) although may have increased ototoxicity.In general, review conclusions were based on a small number of studies with few events in which risk of bias was generally high; interventions were heterogeneous, and outcome definitions were often inconsistent. There were no RCTs evaluating optimal timing of catheter removal and data for automated PD were absent.

Authors' conclusions: Many of the studies evaluating treatment of PD-related peritonitis are small, out-dated, of poor quality, and had inconsistent definitions and dosing regimens. IP administration of antibiotics was superior to IV administration for treating PD-associated peritonitis and glycopeptides appear optimal for complete cure of peritonitis, although evidence for this finding was assessed as low quality. PD catheter removal may be the best treatment for relapsing or persistent peritonitis.Evidence was insufficient to identify the optimal agent, route or duration of antibiotics to treat peritonitis. No specific antibiotic appears to have superior efficacy for preventing treatment failure or relapse of peritonitis, but evidence is limited to few trials. The role of routine peritoneal lavage or urokinase is uncertain.

PubMed Disclaimer

Conflict of interest statement

Professor David Johnson is a consultant for Baxter Healthcare Pty Ltd and has previously received research funds from this company. He has also received speakers' honoraria and research grants from Fresenius Medical Care. Angela Ballinger received a student stipend for a summer studentship 2011 to 2012 from the University of Otago to assist with completing this research. Suetonia Palmer received a fellowship administered by the Consorzio Mario Negri Sud from Amgen Dompe for assistance with travel for collaboration and supervision. The other authors had no known conflicts of interest.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
1.1
1.1. Analysis
Comparison 1 Intravenous (IV) versus intraperitoneal (IP) antibiotics, Outcome 1 Primary treatment failure.
1.2
1.2. Analysis
Comparison 1 Intravenous (IV) versus intraperitoneal (IP) antibiotics, Outcome 2 Adverse events.
1.3
1.3. Analysis
Comparison 1 Intravenous (IV) versus intraperitoneal (IP) antibiotics, Outcome 3 Infusion pain.
2.1
2.1. Analysis
Comparison 2 Oral versus intraperitoneal (IP) antibiotics (same antibiotic), Outcome 1 Primary treatment failure.
2.2
2.2. Analysis
Comparison 2 Oral versus intraperitoneal (IP) antibiotics (same antibiotic), Outcome 2 Relapse.
2.3
2.3. Analysis
Comparison 2 Oral versus intraperitoneal (IP) antibiotics (same antibiotic), Outcome 3 Failure to achieve complete cure.
2.4
2.4. Analysis
Comparison 2 Oral versus intraperitoneal (IP) antibiotics (same antibiotic), Outcome 4 Catheter removal.
2.5
2.5. Analysis
Comparison 2 Oral versus intraperitoneal (IP) antibiotics (same antibiotic), Outcome 5 Hospitalisation rate.
2.6
2.6. Analysis
Comparison 2 Oral versus intraperitoneal (IP) antibiotics (same antibiotic), Outcome 6 Adverse events.
3.1
3.1. Analysis
Comparison 3 Oral versus intraperitoneal (IP) antibiotics (different antibiotics), Outcome 1 Failure to achieve complete cure.
3.2
3.2. Analysis
Comparison 3 Oral versus intraperitoneal (IP) antibiotics (different antibiotics), Outcome 2 Primary treatment failure.
3.3
3.3. Analysis
Comparison 3 Oral versus intraperitoneal (IP) antibiotics (different antibiotics), Outcome 3 Relapse.
3.4
3.4. Analysis
Comparison 3 Oral versus intraperitoneal (IP) antibiotics (different antibiotics), Outcome 4 Catheter removal.
3.5
3.5. Analysis
Comparison 3 Oral versus intraperitoneal (IP) antibiotics (different antibiotics), Outcome 5 Hospitalisation rate.
3.6
3.6. Analysis
Comparison 3 Oral versus intraperitoneal (IP) antibiotics (different antibiotics), Outcome 6 All‐cause mortality.
3.7
3.7. Analysis
Comparison 3 Oral versus intraperitoneal (IP) antibiotics (different antibiotics), Outcome 7 Microbiological eradication.
3.8
3.8. Analysis
Comparison 3 Oral versus intraperitoneal (IP) antibiotics (different antibiotics), Outcome 8 Adverse events.
4.1
4.1. Analysis
Comparison 4 Any oral versus any intraperitoneal (IP), Outcome 1 Treatment failure.
5.1
5.1. Analysis
Comparison 5 Low versus high dose antibiotic, Outcome 1 Failure to achieve complete cure.
5.2
5.2. Analysis
Comparison 5 Low versus high dose antibiotic, Outcome 2 Relapse.
5.3
5.3. Analysis
Comparison 5 Low versus high dose antibiotic, Outcome 3 Seizures.
6.1
6.1. Analysis
Comparison 6 Intermittent versus continuous antibiotics, Outcome 1 Failure to achieve complete cure.
6.2
6.2. Analysis
Comparison 6 Intermittent versus continuous antibiotics, Outcome 2 Primary treatment failure.
6.3
6.3. Analysis
Comparison 6 Intermittent versus continuous antibiotics, Outcome 3 Relapse.
6.4
6.4. Analysis
Comparison 6 Intermittent versus continuous antibiotics, Outcome 4 Catheter removal.
6.5
6.5. Analysis
Comparison 6 Intermittent versus continuous antibiotics, Outcome 5 Rash.
7.1
7.1. Analysis
Comparison 7 First generation cephalosporin versus glycopeptide‐based intraperitoneal (IP) antibiotic regimen, Outcome 1 Failure to achieve complete cure.
7.2
7.2. Analysis
Comparison 7 First generation cephalosporin versus glycopeptide‐based intraperitoneal (IP) antibiotic regimen, Outcome 2 Primary treatment failure.
7.3
7.3. Analysis
Comparison 7 First generation cephalosporin versus glycopeptide‐based intraperitoneal (IP) antibiotic regimen, Outcome 3 Relapse.
7.4
7.4. Analysis
Comparison 7 First generation cephalosporin versus glycopeptide‐based intraperitoneal (IP) antibiotic regimen, Outcome 4 Catheter removal.
7.5
7.5. Analysis
Comparison 7 First generation cephalosporin versus glycopeptide‐based intraperitoneal (IP) antibiotic regimen, Outcome 5 Microbiological eradication.
8.1
8.1. Analysis
Comparison 8 Teicoplanin versus vancomycin‐based intraperitoneal (IP) antibiotic regimen, Outcome 1 Primary treatment failure.
8.2
8.2. Analysis
Comparison 8 Teicoplanin versus vancomycin‐based intraperitoneal (IP) antibiotic regimen, Outcome 2 Failure to achieve complete cure.
8.3
8.3. Analysis
Comparison 8 Teicoplanin versus vancomycin‐based intraperitoneal (IP) antibiotic regimen, Outcome 3 Relapse.
9.1
9.1. Analysis
Comparison 9 Comparison of two oral antibiotic regimens, Outcome 1 Failure to achieve complete cure.
9.2
9.2. Analysis
Comparison 9 Comparison of two oral antibiotic regimens, Outcome 2 Catheter removal.
9.3
9.3. Analysis
Comparison 9 Comparison of two oral antibiotic regimens, Outcome 3 Change in antibiotics following culture results.
9.4
9.4. Analysis
Comparison 9 Comparison of two oral antibiotic regimens, Outcome 4 Adverse events.
10.1
10.1. Analysis
Comparison 10 Fibrinolytic agents versus non‐urokinase or placebo, Outcome 1 Failure to achieve complete cure.
10.2
10.2. Analysis
Comparison 10 Fibrinolytic agents versus non‐urokinase or placebo, Outcome 2 Primary treatment failure (persistent peritonitis).
10.3
10.3. Analysis
Comparison 10 Fibrinolytic agents versus non‐urokinase or placebo, Outcome 3 Relapse.
10.4
10.4. Analysis
Comparison 10 Fibrinolytic agents versus non‐urokinase or placebo, Outcome 4 Catheter removal.
10.5
10.5. Analysis
Comparison 10 Fibrinolytic agents versus non‐urokinase or placebo, Outcome 5 All‐cause mortality.
11.1
11.1. Analysis
Comparison 11 Urokinase versus simultaneous catheter removal or replacement, Outcome 1 Recurrence of peritonitis.
12.1
12.1. Analysis
Comparison 12 Peritoneal lavage, Outcome 1 Failure to achieve complete cure.
12.2
12.2. Analysis
Comparison 12 Peritoneal lavage, Outcome 2 Relapse.
12.3
12.3. Analysis
Comparison 12 Peritoneal lavage, Outcome 3 Technique failure.
12.4
12.4. Analysis
Comparison 12 Peritoneal lavage, Outcome 4 Adverse events.
13.1
13.1. Analysis
Comparison 13 Intraperitoneal immunoglobulin, Outcome 1 Number of exchanges for reduction in dialysate WWC < 100/mL.
13.2
13.2. Analysis
Comparison 13 Intraperitoneal immunoglobulin, Outcome 2 Relapse.
14.1
14.1. Analysis
Comparison 14 Comparison of two intraperitoneal antibiotic regimens, Outcome 1 Failure to achieve complete cure.
14.2
14.2. Analysis
Comparison 14 Comparison of two intraperitoneal antibiotic regimens, Outcome 2 Primary treatment failure.
14.3
14.3. Analysis
Comparison 14 Comparison of two intraperitoneal antibiotic regimens, Outcome 3 Relapse.
14.4
14.4. Analysis
Comparison 14 Comparison of two intraperitoneal antibiotic regimens, Outcome 4 Death due to peritonitis.
14.5
14.5. Analysis
Comparison 14 Comparison of two intraperitoneal antibiotic regimens, Outcome 5 Hospitalisation rate.
14.6
14.6. Analysis
Comparison 14 Comparison of two intraperitoneal antibiotic regimens, Outcome 6 Infusion pain.
14.7
14.7. Analysis
Comparison 14 Comparison of two intraperitoneal antibiotic regimens, Outcome 7 Catheter removal.
14.8
14.8. Analysis
Comparison 14 Comparison of two intraperitoneal antibiotic regimens, Outcome 8 All‐cause mortality.
14.9
14.9. Analysis
Comparison 14 Comparison of two intraperitoneal antibiotic regimens, Outcome 9 Microbiological eradication.
14.10
14.10. Analysis
Comparison 14 Comparison of two intraperitoneal antibiotic regimens, Outcome 10 Adverse events.
15.1
15.1. Analysis
Comparison 15 Intravenous (IV) vancomycin and dialysate gentamicin: 21 days versus 10 days, Outcome 1 Relapse.
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References

References to studies included in this review

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Lye 1993 {published data only}
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Merchant 1992 {published data only}
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Tapson 1990 {published data only}
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Vargemezis 1989 {published data only}
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Velasquez‐Jones 1995 {published data only}
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Wale 1992 {published data only}
    1. Wale MCJ, Finch RG, Morgan AG, Burden RP, Holliday A. A prospective randomised trial of teicoplanin plus aztreonam versus cefuroxime in CAPD peritonitis. International Journal of Antimicrobial Agents 1992;1(Suppl 1):S7‐14. [EMBASE: 1992053370]
Were 1992 {published data only}
    1. Mistry CD, Salgia P, Manos J, Tooth A, Ramsden RT, Marsden A, et al. Netilmicin (N) and Vancomycin (V) in the treatment of peritonitis in patients on CAPD [abstract]. Kidney International 1985;28(2):309. [CENTRAL: CN‐00626106]
    1. Were AJ, Marsden A, Tooth A, Ramsden R, Mistry CD, Gokal R. Netilmycin and vancomycin in the treatment of peritonitis in CAPD patients. Clinical Nephrology 1992;37(4):209‐13. [MEDLINE: ] - PubMed
Williams 1989 {published data only}
    1. Williams AJ, Boletis I, Johnson BF, Raftery AT, Cohen GL, Moorhead PJ, et al. Tenckhoff catheter replacement or intraperitoneal urokinase: a randomised trial in the management of recurrent continuous ambulatory peritoneal dialysis (CAPD) peritonitis. Peritoneal Dialysis International 1989;9(1):65‐7. [MEDLINE: ] - PubMed
Wong 2001 {published data only}
    1. Wong KM, Chan YH, Cheung CY, Wai LC, Choi KS, Leung SH, et al. Cefepime versus vancomycin plus netilmicin therapy for continuous ambulatory peritoneal dialysis‐associated peritonitis. American Journal of Kidney Diseases 2001;38(1):127‐31. [MEDLINE: ] - PubMed

References to studies excluded from this review

Albin 1986 {published data only}
    1. Albin H, Ragnaud JM, Demotes‐Mainard F, Vincon G, Couzineau M, Wone C. Pharmacokinetics of intravenous and intraperitoneal ceftriaxone in chronic ambulatory peritoneal dialysis. European Journal of Clinical Pharmacology 1986;31(4):479‐83. [MEDLINE: ] - PubMed
Al‐Wali 1992 {published data only}
    1. Al‐Wali W, Baillod RA, Brumfitt W, Hamilton‐Miller JMT. Teicoplanin in the treatment of peritonitis in patients receiving continuous ambulatory peritoneal dialysis: a comparative trial against vancomycin. International Journal of Antimicrobial Agents 1992;1(Suppl 1):S1‐6. [EMBASE: 1992053369]
Artic 1997 {published data only}
    1. Artic S, Busch T, Sahin K, Grabensee B, Plum J. Oral versus intraperitoneal application of clindamycin in tunnel infections: a prospective, randomized study in CAPD patients [abstract]. Journal of the American Society of Nephrology 1997;8(Program & Abstracts):260A‐1A. - PubMed
Bannister 1987 {published data only}
    1. Bannister DK, Acchiardo SR, Moore LW, Kraus AP Jr. Nutritional effects of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. Journal of the American Dietetic Association 1987;87(1):53‐6. [MEDLINE: ] - PubMed
Casey 2000 {published data only}
    1. Casey M, Taylor J, Clinard P, Graham A, Mauck V, Spainhour L, et al. Application of mupirocin cream at the catheter exit site reduces exit‐site infections and peritonitis in peritoneal dialysis patients. Peritoneal Dialysis International 2000;20(5):566‐8. [MEDLINE: ] - PubMed
Cavdar 2004 {published data only}
    1. Cavdar C, Saglam F, Sifil A, Celik A, Atay T, Gungor O, et al. Effect of once‐a‐week vs thrice‐a‐week application of mupirocin on methicillin and mupirocin resistance in peritoneal dialysis patients: three years of experience. Renal Failure 2008;30(4):417‐22. [MEDLINE: ] - PubMed
    1. Cavdar C, Zeybel M, Atay T, Sifil A, Sanlidag C, Gulay Z, et al. The effects of once‐ or thrice‐weekly mupirocin application on mupirocin resistance in patients on continuous ambulatory peritoneal dialysis‐‐first 6 months' experience. Advances in Peritoneal Dialysis 2004;20:62‐6. [MEDLINE: ] - PubMed
Celik 1999 {published data only}
    1. Celik A, Cirit M, Tunger A, Akcicek F, Basci A. Treatment of CAPD peritonitis with oral trimethoprim/sulfamethoxazole and intraperitoneal aminoglycoside combination. Peritoneal Dialysis International 1999;19(3):284‐5. [MEDLINE: ] - PubMed
Chadwick 1999 {published data only}
    1. Chadwick DH, Agarwal S, Vora BJ, Hair M, McKewan A, Gokal R. Outcome of peritonitis treated with intraperitoneal (i.p.) weekly vancomycin and i.p. daily netilmicin. Journal of Nephrology 1999;12(5):318‐21. [MEDLINE: ] - PubMed
Chaimovitz 1994 {published data only}
    1. Chaimovitz C. Peritoneal dialysis. Kidney International 1994;45(4):1226‐40. [MEDLINE: ] - PubMed
Danielsson 1997 {published data only}
    1. Danielsson A, Blohme L, Tranaeus A, Hylander B. Prospective randomized study of the impact a subcutaneous rest‐period of a PD‐catheter has on the incidence of peritonitis [abstract no: A0832]. Journal of the American Society of Nephrology 1997;8(Program & Abstracts):178A. [CENTRAL: CN‐00444979]
de Fijter 1989 {published data only}
    1. Fijter CW, Verbrugh HA, Heezius HC, Bronswijk H, MJ, Oe PL, et al. Are intracellularly penetrating antibiotics warranted in CAPD‐related peritonitis?. Advances in Peritoneal Dialysis 1989;5:124‐7. [MEDLINE: ] - PubMed
    1. Fijter CW, Verbrugh HA, Heezius HC, Meulen J, et al. Are intracellularly penetrating antibiotics warranted in treating CAPD peritonitis caused by Staphylococcus epidermidis? [abstract]. Nephrology Dialysis Transplantation 1989;4(8):752. [CENTRAL: CN‐00445019]
De Groc 1983 {published data only}
    1. Groc F, Rottembourg J, Jacq D, Jarlier V, N'Guyen J, Legrain M. Peritonitis during continuous ambulatory peritoneal dialysis. Lavage treatment or not? A prospective study [Les peritonites au cours de la dialyse peritoneale continue ambulatoire. Traitement par lavage ou non? Etude prospective]. Nephrologie 1983;4(1):24‐7. [MEDLINE: ] - PubMed
Dratwa 1987 {published data only}
    1. Dratwa M, Glupczynski Y, Lameire N, Matthys D, Verschraegen G, Eeckhoute M, et al. Aztreonam in CAPD peritonitis. Lancet 1987;2(8552):213‐4. [MEDLINE: ] - PubMed
Dryden 1993 {published data only}
    1. Dryden M, Eykyn SJ. Short‐course gentamicin in gram‐negative CAPD peritonitis. Lancet 1993;341(8843):497. [MEDLINE: ] - PubMed
Durand 1994 {published data only}
    1. Durand PY, Chanliau J, Gamberoni J, Mariot A, Kessler M. UV‐flash: clinical evaluation in 97 patients; results of a French multicenter trial. Peritoneal Dialysis International 1994;14(1):86‐9. [MEDLINE: ] - PubMed
Ersoy 1998 {published data only}
    1. Ersoy FF, Sezer T, Sarikaya M, Suleymanlar G, Yakupoglu G. Treatment of CAPD peritonitis with intraperitoneal ampicillin/sulbactam‐aminoglycoside combination. Peritoneal Dialysis International 1998;18(2):233‐4. [MEDLINE: ] - PubMed
Fabbri 1982 {published data only}
    1. Fabbri L, Grimaldi C, Zucchelli P. Peritonitis in CAPD: treatment with chlorhexidine. Dialysis and Transplantation 1982;11(6):483‐6. [EMBASE: 1982244782]
Flanigan 1994 {published data only}
    1. Flanigan MJ, Hochstetler LA, Langholdt D, Lim VS. Continuous ambulatory peritoneal dialysis catheter infections: diagnosis and management. Peritoneal Dialysis International 1994;14(3):248‐54. [MEDLINE: ] - PubMed
Goffin 1997 {published data only}
    1. Goffin E, Pouthier D, Vandercam B, Gigi J, Ypersele de Strihou C. Oral ciprofloxacin to treat bacterial peritonitis associated with peritoneal dialysis. Clinical Nephrology 1996;48(6):391‐2. [MEDLINE: ] - PubMed
Greenbaum 1995 {published data only}
    1. Greenbaum LA, Goodman WG, Holloway M, Chon Y, Gales B, Salusky IB. A prospective evaluation of the peritonitis rates between oral & intraperitoneal calcitriol [abstract]. Journal of the American Society of Nephrology 1995;6(3):531.
Guest 1996 {published data only}
    1. Guest SS, Erickson LJ. Combination therapy involving ciprofloxacin for peritonitis. Peritoneal Dialysis International 1996;16(3):316‐8. [MEDLINE: ] - PubMed
Hancock 1989 {published data only}
    1. Hancock K, Hulme B. Treatment of CAPD peritonitis with oral ciprofloxacin. Nephrology Dialysis Transplantation 1989;4(8):759. [EMBASE: 1989278988] - PubMed
ISRCTN39675087 {published data only}
    1. ISRCTN39675087. Efficacy of endoluminal brushes reducing peritonitis in peritoneal dialysis (PD) patients. http://controlled‐trials.com/ISRCTN39675087 2006.
Keller 1984 {published data only}
    1. Keller E, Jansen A, Pelz K, Hoppe‐Seyler G, Schollmeyer P. Intraperitoneal and intravenous cefoperazone kinetics during continuous ambulatory peritoneal dialysis. Clinical Pharmacology & Therapeutics 1984;35(2):208‐13. [MEDLINE: ] - PubMed
Klaus 2002 {published data only}
    1. Klaus G, Baum H, Wuhl E, Schaefer F, European Pediatric Peritoneal Dialysis Study Group (EPPS). Efficacy of mupirocin prophylaxis in reducing the incidence of peritoneal dialysis (PD)‐related Staphylococcus aureus infections in children on chronic PD: results of a double blind, placebo‐controlled trial [abstract]. Peritoneal Dialysis International 2002;22(1):149. [CENTRAL: CN‐00401508]
    1. Oh J, von BH, Klaus G, Schaefer F. Nasal carriage of Staphylococcus aureus in families of children on peritoneal dialysis. European Pediatric Peritoneal Dialysis Study Group (EPPS). Advances in Peritoneal Dialysis 2000;16:324‐7. [MEDLINE: ] - PubMed
Lai 1997 {published data only}
    1. Lai MN, Kao MT, Chen CC, Cheung SY, Chung WK. Intraperitoneal once‐daily dose of cefazolin and gentamicin for treating CAPD peritonitis. Peritoneal Dialysis International 1997;17(1):87‐9. [MEDLINE: ] - PubMed
Levesque 2003 {published data only}
    1. Levesque R, Lemieux C, Laverdiere M, Pichette V. Treatment of gram‐positive peritonitis in peritoneal dialysis patients: cefazolin or vancomycin?. Peritoneal Dialysis International 2003;23(6):599‐601. [MEDLINE: ] - PubMed
Li 2000 {published data only}
    1. Li PK, Ip M, Law MC, Szeto CC, Leung CB, Wong TY, et al. Use of intraperitoneal cefepime as monotherapy in treatment of CAPD peritonitis. Peritoneal Dialysis International 2000;20(2):232‐4. [MEDLINE: ] - PubMed
McIntosh 1985 {published data only}
    1. McIntosh ME, Smith WG, Junor BJ, Forrest G, Brodie MJ. Increased peritoneal permeability in patients with peritonitis undergoing continuous ambulatory peritoneal dialysis. European Journal of Clinical Pharmacology 1985;28(2):187‐91. [MEDLINE: ] - PubMed
Mylotte 1999 {published data only}
    1. Mylotte JM, Kahler L, Jackson E. "Pulse" nasal mupirocin maintenance regimen in patients undergoing continuous ambulatory peritoneal dialysis. Infection Control and Hospital Epidemiology 1999;20(11):741‐5. [MEDLINE: ] - PubMed
Plum 1997a {published data only}
    1. Plum J, Artik S, Busch T, Sahin K, Grabensee B. Oral versus intraperitoneal application of clindamycin in tunnel infections: a prospective, randomized study in CAPD patients. Peritoneal Dialysis International 1997;17(5):486‐92. [MEDLINE: ] - PubMed
Posthuma 1997 {published data only}
    1. Peers E. Icodextrin plus glucose combinations for use in CAPD. Peritoneal Dialysis International 1997;17 Suppl 2:S68‐9. [MEDLINE: ] - PubMed
    1. Posthuma N, Verbrugh HA, Donker AJ, Dorp W, Dekker HA, Peers EM, et al. Peritoneal kinetics and mesothelial markers in CCPD using icodextrin for daytime dwell for two years. Peritoneal Dialysis International 2000;20(2):174‐80. [MEDLINE: ] - PubMed
    1. Posthuma N, ter Wee P, Donker AJ, Dekker HA, Oe PL, Verbrugh HA. Peritoneal defense using icodextrin or glucose for daytime dwell in CCPD patients. Peritoneal Dialysis International 1999;19(4):334‐42. [MEDLINE: ] - PubMed
    1. Posthuma N, ter Wee PM, Donker AJ, Dekker HAT, Oe PL, Verhoef J, et al. Ex vivo peritoneal defense characteristics and peritonitis rate in CCPD patients using glucose or icodextrin as daytime dwell [abstract]. Journal of the American Society of Nephrology 1998;9(Program & Abstracts):223A. [CENTRAL: CN‐00447263]
    1. Posthuma N, ter Wee PM, Donker AJ, Oe LP, Verbrugh HA, Peers E. Disaccharide ("total maltose") levels in CCPD patients using icodextrin [abstract]. Journal of the American Society of Nephrology 1995;6(3):513. [CENTRAL: CN‐00485460]
Qamar 2009 {published data only}
    1. Qamar M, Sheth H, Bender F H, Piraino B. Clinical outcomes in peritoneal dialysis: impact of continuous quality improvement initiatives. Advances in Peritoneal Dialysis 2009;25:76‐9. [MEDLINE: ] - PubMed
Ranganathan 2010 {published data only}
    1. Ranganathan D, Baer R, Fassett RG, Williams N, Han T, Watson M, et al. Randomised Controlled Trial to determine the appropriate time to initiate peritoneal dialysis after insertion of catheter to minimise complications (Timely PD study). BMC Nephrology 2010;11(1). - PMC - PubMed
Read 1985 {published data only}
    1. Read DJ, Will EJ, Guillou PJ, Aparicio SR. Extended antibiotic treatment does not prevent early recurrence of CAPD peritonitis. Lancet 1985;1(8419):47. [MEDLINE: ] - PubMed
Restrepo 2010 {published data only}
    1. Restrepo C, Chacon J, Manjarres G. Fungal peritonitis in peritoneal dialysis patients: successful prophylaxis with fluconazole, as demonstrated by prospective randomized control trial. Peritoneal Dialysis International 2010;30(6):619‐25. [MEDLINE: ] - PubMed
Sharma 1971 {published data only}
    1. Sharma BK, Rodriguez H, Gandhi VC, Smith EC, Pillay VK, Dunea G. Trial of oral neomycin during peritoneal dialysis. American Journal of the Medical Sciences 1971;262(3):175‐8. [MEDLINE: ] - PubMed
Sit 2007 {published data only}
    1. Sit D, Kadiroglu AK, Kayabasi H, Yilmaz ME. Prophylactic intranasal mupirocin ointment in the treatment of peritonitis in continuous ambulatory peritoneal dialysis patients. Advances in Therapy 2007;24(2):387‐93. [MEDLINE: ] - PubMed
Stegmayr 1991 {published data only}
    1. Stegmayr BG, Granbom L, Tranaeus A, Wikdahl AM. Reduced risk for peritonitis in CAPD with the use of a UV connector box. Peritoneal Dialysis International 1991;11(2):128‐30. [MEDLINE: ] - PubMed
Stein 1995 {published data only}
    1. Stein A, Baker F, Moorhouse J, Walls J. Peritonitis rate: traditional versus low calcium dialysate. American Journal of Kidney Diseases 1995;26(4):632‐3. [MEDLINE: ] - PubMed
    1. Stein A, Moorhouse J, Baker F, Walls J. Peritonitis rate: traditional versus low‐calcium dialysate [abstract]. Nephrology Dialysis Transplantation 1995;10(5):742. [CENTRAL: CN‐00118917] - PubMed
Thomae 1982 {published data only}
    1. Thomae U, Boos W, Adam D. Transperitoneal resorption of ampicillin, cefuroxim and gentamicin in continuous ambulatory peritoneal dialysis. Medizinische Welt 1982;33(5):182‐4. [MEDLINE: ] - PubMed
van der Muelen 1989 {published data only}
    1. Meulen J, Fijter CW, et al. Initial cephradine (C) monotherapy, frequent cause of complicated peritonitis in continuous ambulatory peritoneal dialysis (CAPD) [abstract]. European Journal of Clinical Investigation 1989;19(2 (Pt II)):A48. [CENTRAL: CN‐00253833]
Varghese 2002 {published data only}
    1. Ranganathan D, Varghese JM, Fassett RG, Lipman J, D'Intini V, Healy H, et al. Optimising intraperitoneal gentamicin dosing in peritoneal dialysis patients with peritonitis (GIPD) study. BMC Nephrology 2009;10(1). - PMC - PubMed
    1. Varghese JM, Roberts JA, Wallis SC, Boots RJ, Healy H, Fassett RG, et al. Pharmacokinetics of intraperitoneal gentamicin in peritoneal dialysis patients with peritonitis (GIPD study). Clinical Journal of The American Society of Nephrology: CJASN 2002;7(8):1249‐56. [MEDLINE: ] - PMC - PubMed
Wang 1996 {published data only}
    1. Wang AY, Li PK, Lai KN. Comparison of intraperitoneal administration of two preparations of vancomycin in causing chemical peritonitis. Peritoneal Dialysis International 1996;16(25):172‐4. [MEDLINE: ] - PubMed
Warady 2003 {published data only}
    1. Warady BA, Ellis EN, Fivush BA, Lum GM, Alexander SR, Brewer ED, et al. "Flush before fill" in children receiving automated peritoneal dialysis. Peritoneal Dialysis International 2003;23(5):493‐8. [MEDLINE: ] - PubMed
Watkins 1998 {published data only}
    1. Watkins S, Warady B, Ogrinc F, Schlichting L. Impact of flush‐before‐fill methodology on peritonitis rates in patients receiving automated peritoneal dialysis [abstract]. Journal of the American Society of Nephrology 1998;9(Program & Abstracts):194A. [CENTRAL: CN‐00448293]
Wong 2004b {published data only}
    1. Wong FS, Chau S, Chow N, Ho JC, Cheng Y, Yu AW. Effect of changing transfer set on relapse of bacterial peritonitis. Hong Kong Journal of Nephrology 2004;6(2):87‐91. [EMBASE: 2004491078]
Yudis 1995 {published data only}
    1. Yudis M, Sirota RA, Stein HD, Snipes ER, Gronich JH. Intravenous (iv) vs. intraperitoneal (ip) vancomycin (vanco) in staphylococcal peritonitis (sp) [abstract]. Journal of the American Society of Nephrology 1995;6(3):569. [CENTRAL: CN‐00486558]
Zacherle 1996 {published data only}
    1. Zacherle BJ. Oral ciprofloxacin for the first‐phase treatment of peritonitis associated with continuous ambulatory peritoneal dialysis. Journal of the American Society of Nephrology 1996;7(5):811‐2. [MEDLINE: ] - PubMed
Zhang 1993 {published data only}
    1. Zhang D, Ye R, Wu X, et al. A new treatment program for continuous ambulatory peritoneal dialysis‐related peritonitis [abstract]. Journal of the American Society of Nephrology 1993;4(Program & Abstracts):422. [CENTRAL: CN‐00486575]

References to ongoing studies

ISRCTN74962920 {published data only}
    1. ISRCTN74962920. A single centre randomised study to assess the need for performing a line change when a peritoneal dialysis patient presents with peritonitis. controlled‐trials.com/ISRCTN74962920 (accessed 17 June 2013). [ISRCTN74962920]
NCT01785641 {published data only}
    1. NCT01785641. Single versus combined antibiotic therapy for bacterial peritonitis in CAPD patients. http://clinicaltrials.gov/ct2/results?term=NCT01785641 (accessed 4 July 2013).

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