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Treatment for peritoneal dialysis-associated peritonitis

  1. Angela E Ballinger1,
  2. Suetonia C Palmer1,
  3. Kathryn J Wiggins2,*,
  4. Jonathan C Craig3,4,
  5. David W Johnson5,
  6. Nicholas B Cross6,
  7. Giovanni FM Strippoli3,4,7,8,9,10

Editorial Group: Cochrane Renal Group

Published Online: 26 APR 2014

Assessed as up-to-date: 5 MAR 2014

DOI: 10.1002/14651858.CD005284.pub3


How to Cite

Ballinger AE, Palmer SC, Wiggins KJ, Craig JC, Johnson DW, Cross NB, Strippoli GFM. Treatment for peritoneal dialysis-associated peritonitis. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD005284. DOI: 10.1002/14651858.CD005284.pub3.

Author Information

  1. 1

    University of Otago Christchurch, Department of Medicine, Christchurch, New Zealand

  2. 2

    Royal Melbourne Hospital, Departments of Nephrology and General Medicine, Melbourne, VIC, Australia

  3. 3

    The University of Sydney, Sydney School of Public Health, Sydney, NSW, Australia

  4. 4

    The Children's Hospital at Westmead, Cochrane Renal Group, Centre for Kidney Research, Westmead, NSW, Australia

  5. 5

    Princess Alexandra Hospital, Department of Nephrology, Woolloongabba, Queensland, Australia

  6. 6

    Christchurch Public Hospital, Department of Nephrology, Christchurch, New Zealand

  7. 7

    University of Bari, Department of Emergency and Organ Transplantation, Bari, Italy

  8. 8

    Mario Negri Sud Consortium, Department of Clinical Pharmacology and Epidemiology, Santa Maria Imbaro, Italy

  9. 9

    Diaverum, Medical-Scientific Office, Lund, Sweden

  10. 10

    Amedeo Avogadro University of Eastern Piedmont, Division of Nephrology and Transplantation, Department of Translational Medicine, Novara, Italy

*Kathryn J Wiggins, Departments of Nephrology and General Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia. kate.wiggins@mh.org.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 26 APR 2014

SEARCH

 

Background

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
 

Description of the condition

Peritoneal dialysis (PD) is an effective form of renal replacement therapy for people with advanced kidney disease. However, peritonitis continues to represent a significant complication of PD (Voinescu 2002) despite the introduction of effective prevention strategies such as disconnect and double bag systems (Bazzato 1980; Monteon 1998; Strippoli 2004). The reported incidence of peritonitis episodes varies from one in nine patient-months to one in 53 patient-months (Grunberg 2005; Kawaguchi 1999). Risk factors for peritonitis include diabetes mellitus (Oxton 1994), race (Juergensen 2002; Lim 2005), obesity (McDonald 2004), temperate climates (Alves 1993; Szeto 2003), and depression (Troidle 2003). In addition, some studies have shown that PD modality may influence peritonitis rates, although other studies have not confirmed this (Huang 2001; Oo 2005).

PD-associated peritonitis results in significant morbidity, and in some cases, mortality. Catheter removal becomes necessary in cases not responding to antibiotic therapy. This may be temporary and followed by a return to PD, or permanent, resulting in technique failure. Ultrafiltration failure can occur both acutely due to increases in capillary permeability (Ates 2000; Smit 2004) and in the longer term result in technique failure (Coles 2000; Davies 1996). In many countries, peritonitis is a leading cause of permanent transfer to haemodialysis. Peritonitis is prevalent among patients with encapsulating sclerosing peritonitis and may be a causal factor (Kawanishi 2005; Rigby 1998). In some patient groups peritonitis is thought to increase overall mortality rates (Fried 1996). It is estimated that PD-associated peritonitis results in death in 6% of affected patients (Troidle 2006).

 

Description of the intervention

Early and effective management of peritonitis is important to reduce the risk of adverse outcomes such as catheter removal (Choi 2004; Heaf 2004). The mainstay of treatment is antimicrobial therapy, although adjunctive therapies have been employed including the use of fibrinolytic agents (Innes 1994; Pickering 1989), peritoneal lavage (Ejlersen 1991) and routine early catheter removal.

 

How the intervention might work

Current guidelines recommend the use of antibiotics which cover gram positive and gram negative organisms in cases of peritonitis (CARI 2005; Piraino 2005). However, several questions about the optimal treatment of PD-associated peritonitis remain unanswered, particularly with respect to choice, route of administration (Passadakis 2001) and duration of antimicrobial therapy. Many treatment regimens are based on continuous ambulatory PD (CAPD) and their applicability to automated PD (APD) is untested (Fielding 2002). The optimal total duration of antimicrobial therapy, and the duration of systemic (intraperitoneal (IP) or intravenous (IV)) treatment is also unclear, as are the roles of peritoneal lavage and urokinase. The majority of studies performed have focused on the outcomes of empirical antibiotic therapy, with little consideration of treatment initiated once organism identification and sensitivities are available.

 

Why it is important to do this review

To address existing uncertainties, we performed a systematic review of randomised controlled trials (RCT) evidence examining the effectiveness of different treatment options for PD-associated peritonitis.

 

Objectives

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

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

 

Methods

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
 

Criteria for considering studies for this review

 

Types of studies

All RCTs and quasi-RCTs (RCTs in which allocation to treatment was obtained by alternation, use of alternate medical records, date of birth or other predictable methods) on the effect of any interventions, including anti-infective agents, fibrinolytic agents, peritoneal lavage and early catheter removal, for the treatment of peritonitis in PD patients were included.

 

Types of participants

Adult and paediatric patients who were receiving PD (CAPD or APD) and developed PD-associated peritonitis.

 

Types of interventions

Studies looking at the use of any antimicrobial agent, fibrinolytic agent, peritoneal lavage, IP immunoglobulin or early catheter removal were included. Interventions could be tested directly against each other or compared to placebo/no treatment. The following could be included:

  • Studies of the same antibiotic agent administered by different routes (e.g. IP versus oral, IP versus IV).
  • Studies comparing the same antibiotic agent administered at different doses.
  • Studies comparing different schedules of administration of antimicrobial agents (in particular regimens involving single daily dosing versus more than one daily dose).
  • Comparisons of different regimens of antimicrobial agents.
  • Studies comparing different treatment durations with the same antimicrobial agents.
  • Studies comparing any other intervention including fibrinolytic agents, peritoneal lavage, IP immunoglobulin administration, and early catheter removal.

 

Types of outcome measures

 

Primary outcomes

  1. Primary peritonitis treatment failure (failure to achieve a clinical response, defined as resolution of symptoms and signs, by day 4 to 6)
  2. Complete cure (clinical or microbiological improvement or both with no subsequent relapse)
  3. Peritonitis relapse (reoccurrence of peritonitis due to the same organism with the same antibiotic sensitivities within 28 days of completing treatment)
  4. Death due to peritonitis (all-cause mortality data were also collected)
  5. Toxicity of antibiotic treatments (ototoxicity, decline in residual kidney function, rash, nausea and vomiting, convulsions, other).

 

Secondary outcomes

  1. Time to peritonitis relapse
  2. Need to change antibiotic following culture results
  3. Catheter removal or replacement or both
  4. Hospitalisation (duration of hospital stay) and hospitalisation rate (number of patients hospitalised)
  5. Technique failure (transfer from PD to haemodialysis or transplantation due to peritonitis).

 

Search methods for identification of studies

 

Electronic searches

For this update we searched the Cochrane Renal Group's Specialised Register and EMBASE to 5 March 2014 without language restriction.

The Cochrane Renal Group’s Specialised Register contains studies identified from:

  1. Monthly searches of the Cochrane Central Register of Controlled Trials (CENTRAL)
  2. Weekly searches of MEDLINE OVID SP
  3. Handsearching of renal-related journals and the proceedings of major renal conferences
  4. Searching of the current year of EMBASE OVID SP
  5. Weekly current awareness alerts for selected renal journals
  6. Searches of the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov.

Studies contained in the Specialised Register are identified through search strategies for CENTRAL, MEDLINE, and EMBASE based on the scope of the Cochrane Renal Group. Details of these strategies, as well as a list of handsearched journals, conference proceedings and current awareness alerts, are available in the Specialised Register section of information about the Cochrane Renal Group.

Please refer to our review published in 2008 for the original search strategies used (Wiggins 2008).

 

Searching other resources

  1. Reference lists of clinical practice guidelines, review articles and relevant studies.
  2. Letters seeking information about unpublished or incomplete studies to investigators known to be involved in previous studies.

 

Data collection and analysis

 

Selection of studies

The original review was undertaken by four authors in 2008 and seven authors in 2014. The search strategies described were used to obtain titles and abstracts of studies that might be relevant to the review. The titles and abstracts were screened independently by multiple authors, who discarded studies that were not eligible based on the inclusion criteria for this review; however studies and reviews that might include relevant data or information on additional published or unpublished studies were retained initially and their full-text version was analysed.

 

Data extraction and management

Four authors independently assessed the retrieved abstracts, and if necessary, the full text of these studies to determine eligibility. Data extraction was carried out independently by the same authors using standard data extraction forms. Studies reported in non-English language journals were translated before assessment. Where more than one publication of one study existed, reports were grouped together and the publication with the most complete data was used in the analyses. Where relevant outcomes were only published in earlier versions these data were used Disagreements were resolved in consultation among authors.

 

Assessment of risk of bias in included studies

The following items were independently assessed by two authors using the risk of bias assessment tool (Higgins 2011) (see Appendix 2).

  • Was there adequate sequence generation (selection bias)?
  • Was allocation adequately concealed (selection bias)?
  • Was knowledge of the allocated interventions adequately prevented during the study (detection bias)?
    • Participants and personnel
    • Outcome assessors
  • Were incomplete outcome data adequately addressed (attrition bias)?
  • Are reports of the study free of suggestion of selective outcome reporting (reporting bias)?
  • Was the study apparently free of other problems that could put it at a risk of bias?

 

Measures of treatment effect

Results were expressed as risk ratio (RR) with 95% confidence intervals (CI) for all categorical outcomes of the individual studies.

 

Dealing with missing data

Any further information or clarification required from the authors was requested by written or electronic correspondence and relevant information obtained in this manner was included in the review. Evaluation of important numerical data such as screened, randomised patients as well as intention-to-treat (ITT), as-treated and per-protocol (PP) population was performed. Attrition rates, for example drop-outs, losses to follow-up and withdrawals were investigated. Issues of missing data and imputation methods (for example, last-observation-carried-forward (LOCF)) were critically appraised (Higgins 2011).

 

Assessment of heterogeneity

Heterogeneity was analysed using a Chi² test on N-1 degrees of freedom, with an alpha of 0.05 used for statistical significance and with the I² statistic (Higgins 2003). I² values of 25%, 50% and 75% correspond to low, medium and high levels of heterogeneity.

 

Assessment of reporting biases

It was planned that if sufficient RCTs were identified an attempt would be made to assess funnel plot asymmetry due to small study effect, as this may be indicative of publication bias (Egger 1997). There were however too few included studies to construct meaningful funnel plots.

 

Data synthesis

Treatment effects were summarised using a random-effects model. For each analysis, the fixed-effect model was also evaluated to ensure robustness of the model chosen and susceptibility to outliers. Where continuous scales of measurement were used to assess the effects of treatment (time to peritonitis relapse, days of hospitalisation, measures of residual kidney function) the mean difference (MD) was used.

 

Subgroup analysis and investigation of heterogeneity

Subgroup analysis was planned to explore how possible sources of heterogeneity (paediatric versus adult population, age, gender, cause of end-stage kidney disease, body mass index, diabetes mellitus, duration of dialysis, PD modality (CAPD versus APD), previous peritonitis episodes, type of dialysate and micro-organism isolated) might influence treatment effect.

 

Sensitivity analysis

We aimed to perform sensitivity analyses to explore the influence of the following factors on effect size:

  • repeating the analysis excluding unpublished studies
  • repeating the analysis taking account of risk of bias
  • repeating the analysis excluding any very long or large studies to establish how much they dominate the results
  • repeating the analysis excluding studies using the following filters: diagnostic criteria, language of publication, source of funding (industry versus other), country.

Data were however insufficient to perform these analyses.

 

Results

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
 

Description of studies

 

Results of the search

The literature search undertaken for Wiggins 2008 retrieved 1684 reports of which 1617 were excluded. Analysis of the remainder identified 36 studies (2089 participants, 2480 peritonitis episodes) published in 42 reports. For this update the Cochrane Renal Group's Specialised Register identified 62 reports of potential studies and two ongoing studies. After full text review a further six eligible studies (344 participants, 533 peritonitis episodes) were identified taking the total number of unique RCTs to 42 (58 reports; 2433 participants, 3013 episodes of peritonitis). Search results are summarised in Figure 1.

 FigureFigure 1. Study flow diagram.

 

Included studies

We identified 36 studies (1949 patients) that considered the use of antimicrobial agents. There were 14 studies that compared different routes of antibiotic administration - IP versus IV (3 studies, 156 participants: Bailie 1987; Bennett-Jones 1987; Vargemezis 1989) and IP versus oral (11 studies, 601 participants: Bennett-Jones 1990; Boeschoten 1985; Chan 1990; Cheng 1991; Cheng 1993; Cheng 1997; Cheng 1998; Gucek 1994; Lye 1993; Raman 1985; Tapson 1990).

Different IP antibiotic classes or combinations or both were tested head-to-head in 17 studies (Bowley 1988; de Fijter 2001; Drinovec 1988; Flanigan 1991; Friedland 1990; Gucek 1997; Hernandez 2004 Jiménez 1996; Khairullah 2002; Klaus 1995a; Leung 2004; Lui 2005; Lupo 1997; Merchant 1992; Wale 1992; Were 1992; Wong 2001). These included three studies (234 participants) that compared glycopeptides to first generation cephalosporins (Flanigan 1991; Khairullah 2002; Lupo 1997); and five studies (421 participants) that compared intermittent and continuous IP antibiotic dosing (Boyce 1988; Choy 2001; Lye 1995; Klaus 1995a; Velasquez-Jones 1995).

There were six studies that investigated adjunctive therapies: urokinase versus placebo (Gadallah 2000c; Innes 1994; Tong 2005a); catheter removal or replacement or both (Williams 1989), peritoneal lavage (Ejlersen 1991), and IP immunoglobulin (Coban 2004). Data for automated PD were absent.

 

Excluded studies

We excluded 49 studies (67 reports). Reasons for exclusion were: not RCTs (19); not appropriate population (24); not peritonitis treatment (2); not appropriate outcomes (4).

 

Risk of bias in included studies

We have summarised the risk of bias of included studies in Figure 2 and Figure 3. In general, risks of bias were in high in most studies. Overall, both blinding and selective reporting were assessed at high risk of bias. Suboptimal reporting in many studies meant that risks of bias were assessed as unknown.

 FigureFigure 2. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
 FigureFigure 3. Risk of bias summary: review authors' judgements about each risk of bias item for each included study

 

Allocation

Random generation sequence was assessed as low risk in four studies (10%) (Chan 1990; Cheng 1991; Lui 2005; Tapson 1990); allocation concealment was adequate in 7/42 (17%) studies (Cheng 1991; Cheng 1998; Friedland 1990; Klaus 1995a; Lui 2005; Tapson 1990; Wong 2001).

 

Blinding

Only three (7%) studies clearly blinded participants and investigators (Cheng 1991; Innes 1994; Tong 2005a).

 

Incomplete outcome data

Percentages of participants lost to follow-up ranged from 0% to 64.5%.

 

Selective reporting

Reporting of outcomes was assessed as low risk in only six (14%) studies (de Fijter 2001; Friedland 1990; Lye 1993; Merchant 1992; Tong 2005a; Wong 2001).

 

Effects of interventions

There were no significant differences in the results of analyses performed using random and fixed-effects models. The results presented therefore refer to those obtained using a random-effects model. Subgroup analyses and evaluations for bias from small-study effects were not performed because the small numbers of participants and studies made the power of these analyses too small to assess. Few data were available on the pharmacokinetics of many commonly used antibiotics when administered intraperitoneally.

 

Intravenous (IV) versus intraperitoneal (IP) antimicrobial agents

Bennett-Jones 1987 reported a statistically significant increase in the primary treatment failure rate for IV versus IP vancomycin and tobramycin ( Analysis 1.1.2 (75 participants): RR 3.52, 95% CI 1.26 to 9.81). It is noteworthy that in the study by Bailie 1987, in which IP versus IV administration of a loading dose of vancomycin followed by an IP maintenance dose were compared, there were no primary treatment failures reported in either group. Vargemezis 1989 also looked at IP versus IV administration of vancomycin; however, reporting limitations made it difficult to interpret meaningful results.

Bailie 1987 reported no significant differences in the incidence of rash ( Analysis 1.2.1 (20 participants): RR 5.00, 95% CI 0.27 to 92.62) or infusion pain ( Analysis 1.3 (20 participants): RR 3.00, 95% CI 0.14 to 65.90) between IV and IP vancomycin. Bennett-Jones 1987 reported no significant difference in hypotension ( Analysis 1.2.2 (76 participants): RR 5.26, 95% CI 0.26 to 106.11) between IV and IP vancomycin and tobramycin.

 

Oral versus IP administration of the same antimicrobial agent

Oral administration of quinolone antibiotics (ciprofloxacin, ofloxacin) had uncertain effects on primary treatment failure compared to IP administration ( Analysis 2.1 (2 studies, 83 participants): RR 1.34, 95% CI 0.71 to 2.56; P = 0.37; I²= 0%) and relapse ( Analysis 2.2 (2 studies, 83 participants): RR 3.38, 95% CI 0.74 to 15.35; P = 0.11; I² = 0%). Assessment of low-quality evidence indicated that IP quinolone therapy may increase complete cure ( Analysis 2.3 (2 studies, 83 participants): RR 1.66, 95% CI 0.98 to 2.83; P = 0.06; I² = 0%) compared with oral treatment, although therapy failure rates were high in both arms of these studies (52.4% and 31.7% in the oral and IP groups, respectively).

Cheng 1993 reported no significant differences in catheter removal rates ( Analysis 2.4 (48 participants): RR 2.00, 95% CI 0.19 to 20.61), hospitalisation rates ( Analysis 2.5 (48 participants): RR 1.00, 95% CI 0.51 to 1.95), or nausea and vomiting ( Analysis 2.6 (48 participants): RR 0.50, 95% CI 0.05 to 5.15) between oral and IP cephalosporin (cephradine) therapy.

 

Oral versus IP administration of different antimicrobial agents

Comparison of oral versus antibiotic regimens had uncertain effects on risks of failure to achieve complete cure ( Analysis 3.1 (8 studies, 510 participants): RR 1.06, 95% CI 0.80 to 1.40; P = 0.69; I² = 0%). Subgroup analysis showed this was similar for oral quinolones versus IP aminoglycoside/glycopeptide combinations ( Analysis 3.1.1 (5 studies, 304 participants): RR 1.19, 95% CI 0.83 to 1.72), oral quinolones versus IP cephalosporins ( Analysis 3.1.2 (2 studies, 148 participants): RR 1.00, 95% CI 0.55 to 1.81), and oral cephradine versus IP cefuroxime ( Analysis 3.1.3 (58 participants): RR 0.77, 95% CI 0.40 to 1.46). Similarly, primary treatment failure ( Analysis 3.2 (7 studies, 472 participants): RR 1.04, 95% CI 0.64 to 2.15; P = 0.86; I² = 0%), relapse ( Analysis 3.3(5 studies, 304 participants): RR 1.17, 95% CI 0.64 to 2.15; P = 0.61; I² = 2%), catheter removal ( Analysis 3.4 (2 studies, 170 participants): RR 1.18, 95% CI 0.49 to 2.87; P = 0.71; I² = 0%), hospitalisation rate ( Analysis 3.5 (1 study, 45 participants): RR 0.70, 95% CI 0.30 to 1.63), all-cause mortality ( Analysis 3.6 (1 study, 46 participants): RR 0.36, 95% CI 0.02 to 8.46), and microbiological eradication (not defined by investigators) ( Analysis 3.7 (1 study, 39 participants): RR 1.26, 95% CI 0.46 to 3.46) were equivalent in both groups. There was an increased risk of nausea and vomiting with oral antibiotics compared to IP antibiotics ( Analysis 3.8.1 (3 studies, 158 participants): RR 9.91, 95% CI 1.89 to 51.99; P = 0.007; I² = 0%).

 

Oral versus IP administration of the same or different antimicrobial agent(s)

When all studies that compared oral versus IP administration of an antimicrobial agent were combined, treatment failure rates of oral versus IP administration were similar without evidence for between-trial heterogeneity ( Analysis 4.1 (9 studies, 555 participants): RR 1.12, 95% CI 0.79 to 1.60; P = 0.52; I² = 0%).

 

Low versus high dose antibiotic

Merchant 1992 reported low dose imipenem (total 1 g IP daily) was associated with a significant increase in failure to achieve complete cure ( Analysis 5.1 (30 participants): RR 4.38, 95% CI 1.27 to 15.06) and the number relapsing ( Analysis 5.2 (28 participants): RR 12.00, 95% CI 1.60 to 90.23) compared with high dose imipenem (total 2 g IP daily). High dose imipenem had an uncertain effect on seizures ( Analysis 5.3 (30 participants): RR 0.60, 95% CI 0.03 to 11.23). However this study was not powered to detect seizures and the protocol was changed mid-study from high dose to low dose imipenem because two participants in the imipenem group had seizures.

 

Intermittent versus continuous IP antimicrobial agents

The effects of intermittent compared with continuous dosing on complete cure ( Analysis 6.1 (4 studies, 338 participants): RR 0.92, 95% CI 0.64 to 1.33; P = 0.65; I² = 0%), primary treatment failure ( Analysis 6.2 (5 studies, 522 participants): RR 1.11, 95% CI 0.77 to 1.62; P = 0.57; I² = 0%) and risk of relapse ( Analysis 6.3 (4 studies, 338 participants): RR 0.76, 95% CI 0.45 to 1.28; P = 0.31; I² = 0%) were uncertain. Choy 2001 reported no significant difference in catheter removal rates between groups ( Analysis 6.4 (20 participants): 0.98, 95% CI 0.43 to 2.24). The only side-effect evaluated was vancomycin-induced rash (Boyce 1988); effects of continuous compared with intermittent dosing were uncertain ( Analysis 6.5 (51 participants): RR 0.70, 95% CI 0.05 to 10.57).

 

First generation cephalosporin versus glycopeptide-based regimens

Achievement of complete cure was significantly more likely with a glycopeptide-based regimen than one based on cephalosporins ( Analysis 7.1 (3 studies, 370 participants): RR 1.66, 95% CI 1.01 to 2.72; P = 0.04; I² = 41%). This was true for both vancomycin ( Analysis 7.1.1 (2 studies, 305 participants): RR 1.51, 95% CI 1.03 to 2.22; P = 0.26; I² = 20%) and teicoplanin-based regimens ( Analysis 7.1.2 (1 study, 65 participants): RR 9.65, 95% CI 1.04 to 20.58). Despite the overall advantage of glycopeptides on complete cure, effects on primary treatment failure ( Analysis 6.2 (2 studies, 305 participants): RR 1.14, 95% CI 0.69 to 1.87; P = 0.38; I² = 0%), relapse ( Analysis 7.3 (3 studies, 350 participants): RR 1.68, 95% CI 0.84 to 3.36; P = 0.14; I² = 0%), catheter removal ( Analysis 7.4 (2 studies, 305 participants): RR 0.95, 95% CI 0.41 to 2.19; P = 0.90; I² = 52%) and microbiological eradication ( Analysis 7.5 (1 study, 45 participants): RR 0.83, 95% CI 0.62 to 1.13) were uncertain likely due to the lack of power within the meta-analysis.

It is noteworthy that these results were largely influenced by Flanigan 1991 in which the cephazolin dose used was 50 mg/L, which is below the dose currently recommended in the International Society for Peritoneal Dialysis (ISPD) guidelines of 125 mg/L (Li 2010). In contrast, Khairullah 2002 found no difference in cure rates for vancomycin and cephazolin (50% and 40% complete cure for glycopeptides and cephalosporins respectively) when a higher cephalosporin dose was used.

 

Teicoplanin versus vancomycin-based IP antibiotic regimens

Primary treatment failure was less likely with teicoplanin than vancomycin ( Analysis 8.1 (2 studies, 178 participants): RR 0.36, 95% CI 0.13 to 0.96; P = 0.04), however, effects on complete cure were uncertain ( Analysis 8.2 (2 studies, 178 participants): RR 0.67, 95% CI 0.40 to 1.15; P = 0.14; I² = 0%). The risk of relapse rates was also similar for both agents ( Analysis 8.3 (2 studies, 178 participants): RR 1.01, 95% CI 0.49 to 2.11; P = 0.97; I² = 0%). There was no significant heterogeneity associated with either outcome.

 

Different regimens of oral antibiotics

Effects of oral rifampicin and ofloxacin (regimen 2) compared with oral ofloxacin alone (regimen 1) (Chan 1990) in achieving a complete cure ( Analysis 9.1 (74 participants): RR 0.88, 95% CI 0.35 to 2.17) and catheter removal ( Analysis 9.2 (74 participants): RR 2.00, 95% CI 0.19 to 21.11) were uncertain. Chan 1990 also reported there was no differences in the need to change antibiotics following culture results ( Analysis 9.3 (74 participants): RR 0.33, 95% CI 0.04 to 3.06), nausea and vomiting ( Analysis 9.4.1 (74 participants): RR 3.00, 95% CI 0.13 to 71.34) and rash ( Analysis 9.4.2 (74 participants): RR 3.00, 95% CI 0.13 to 71.34) between the two regimens.

 

Fibrinolytic agents versus non-urokinase or placebo

Studies of IP urokinase found uncertain effects for benefit of urokinase versus placebo on complete cure in persistent peritonitis ( Analysis 10.1 (88 participants): RR 1.23, 95% CI 0.84 to 1.79), or primary response to treatment in the setting of resistant peritonitis ( Analysis 10.2 (2 studies, 99 participants): RR 0.63, 95% CI 0.32 to 1.26; P = 0.19; I² = 33%). Resistant CAPD peritonitis was defined as either persistent infection or recurrent infection (Innes 1994) or as persistence of symptoms and signs of peritonitis together with turbid peritoneal dialysate 48 hours after the initiation of antibiotic treatment (Tong 2005a). Persistent infection was defined as no resolution of peritonitis within four days of treatment with antibiotics active against the bacteria isolated (Innes 1994). Relapse and catheter removal were uncertain with urokinase, either in the setting of persistent peritonitis ( Analysis 10.3.1;  Analysis 10.4.1) or initiation of fibrinolytic therapy at the time peritonitis was diagnosed ( Analysis 10.3.2;  Analysis 10.4.2). Tong 2005a reported no significant difference in all-cause mortality ( Analysis 10.5).

 

Urokinase versus simultaneous catheter removal and replacement

In Williams 1989, a study of participants presenting with a second recurrence of peritonitis, simultaneous catheter removal and replacement was better than urokinase in reducing recurrent episodes of peritonitis ( Analysis 11.1 (37 participants): RR 2.35, 95% CI 1.13 to 4.91).

 

Peritoneal lavage

Ejlersen 1991 investigated the effects of peritoneal lavage (2 L exchanges during the initial 24 hours, no dwell time with dialysis fluid (60 L) containing vancomycin 20 mg/L and netilmicin) plus nine further days antibiotic treatment compared with continued prolonged exchanges (2 rapid exchanges containing vancomycin (40 mg/L) followed by routine CAPD schedule including antibiotics for 10 days. This study reported no significant differences between lavage and usual care for complete cure ( Analysis 12.1 (36 participants): RR 2.50, 95% CI 0.56 to 11.25), relapse of peritonitis with subsequent laparotomy and colostomy ( Analysis 12.2 (36 participants): RR 2.50, 95% CI 0.56 to 11.25), technical failure ( Analysis 12.3 (36 participants): RR 3.00, 95% CI 0.13 to 69.09), or adverse events ( Analysis 12.4 (36 participants): 3.00, 95% CI 0.13 to 69.09).

 

Intraperitoneal immunoglobulin

Coban 2004 reported the use of IP immunoglobulin was associated with a statistically significant reduction in numbers of exchanges executed for the dialysate white cell count to fall below 100/mL ( Analysis 13.1 (24 participants): MD -7.30 exchanges, 95% CI -8.12 to -6.48). There were no treatment failures and no relapses in any participants in this study.

 

Head-to-head studies

Of the 12 studies in which different regimens of IP antibiotics were compared head-to-head, the only statistically significant outcome was reported by de Fijter 2001: rifampicin/ciprofloxacin was better than cephradine in reducing treatment failure ( Analysis 14.2.7 (98 participants) RR 0.50, 95% CI 0.28 to 0.89).

 

Duration of antibiotic treatment

Altmann 1984 compared duration of antibiotic treatment (vancomycin and gentamicin for 10 versus 21 days) and reported uncertain effects on risk of relapse ( Analysis 15.1 (49 participants): RR 1.56, 95% CI 0.61 to 3.95). It is noteworthy that five participants, all of whom received more than 21 days of gentamicin, developed clinical evidence of vestibular damage versus no patients who received a 10-day course of treatment.

It was not possible to tabulate a summary of findings because there were insufficient studies for each analysis.

 

Discussion

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
 

Summary of main results

This review found that in generally low-quality evidence, IP antibiotic therapy may lower risks of primary treatment failure compared with IV antibiotics in two small studies.

The benefits of intermittent dosing of some antibiotics (vancomycin, gentamicin, ceftazidime and teicoplanin) compared with continuous therapy in the treatment of peritonitis, and of IP versus oral antibiotics, are uncertain.

In a single small study of participants presenting with a second recurrence of peritonitis, simultaneous catheter removal and replacement was superior to urokinase to reduce risks of relapsing and remitting PD-associated peritonitis. Insufficient data were available to determine if specific antibiotic classes are most effective for reducing treatment failure and relapse, although glycopeptides may improve complete cure rates compared with first generation cephalosporins.

It was unclear if peritoneal lavage improves response to concomitant antimicrobial therapy.

We also found that IP immunoglobulin administration decreased the time for the dialysate inflammatory cell count to fall, but effects on patient-important outcomes, such as treatment failure or risk of relapse, are uncertain. Longer duration of antibiotics had unclear effects on risk of relapse compared with shorter treatment courses, and may increase adverse events.

Oral antibiotics were associated with increased risk of nausea and vomiting compared with IP administration.

Data for automated PD were scant.

 

Overall completeness and applicability of evidence

Our review revealed a significant paucity of evidence underlying many widely-used and accepted clinical practices in the treatment of peritonitis, a condition that is associated with significant patient morbidity and mortality. Consequently, some aspects of treatment are uncertain, such as duration of antimicrobial therapy and optimal timing of catheter removal. While valuable information was gained from this review, the few available studies at generally high risk of bias resulted in a lack of evidence in many important areas of clinical practice. Studies tended to focus on choice and route of antibiotic without consideration of other variables such as total duration of therapy, drug dose and the role of patient factors, such as comorbidities and residual kidney function. No RCTs have been conducted to determine if early catheter removal is beneficial in patients not responding to therapy. The follow-up period of most studies was 28 days or fewer; therefore, long-term outcomes, such as technique failure and mortality, were not evaluated. Loss of residual kidney function during peritonitis may be accelerated by aminoglycoside therapy (Baker 2003; Shemin 2000) although this has been refuted by a recent study (Badve 2012). As a result of these factors, there is insufficient evidence regarding several aspects of management that are clinically important and this makes the provision of definitive treatment guidelines difficult at the present time.

 

Quality of the evidence

The risk of bias of included studies was generally moderate-to-high. In particular, inadequate randomisation and concealment methods were common. Definitions of peritonitis, successful treatment, and relapse varied among studies, thereby reducing their comparability. Many studies were conducted in single-centre settings with small patient numbers, and were underpowered to detect short-term (treatment failure and catheter removal), medium-term (relapse and recurrence) or long-term (mortality and technique failure) effects. Similarly, studies did not systematically evaluate adverse events. Hence there was significant potential for type II statistical errors (finding no treatment effect when a treatment effect exists) in most of our analyses. Studies often predated the current era of lower peritonitis rates, newer antibiotic therapies and increased awareness of multiresistant organisms, thereby potentially reducing the applicability of our meta-analyses.

A significant issue was that there was marked heterogeneity among studies of outcome definitions. Treatment failure was variably measured by resolution of symptoms and signs, clearing of dialysate, fall in dialysate white cell count and microbiological eradication of the causative organism. The time frame in which these changes were required to occur also varied, ranging from 48 hours to 28 days. Similarly there was a large degree of variation in the time elapsed after a primary peritonitis episode for a second peritonitis episode to be considered as a relapse (Li 2010).

An additional problem was interaction of endpoints. For example, primary treatment failure often necessitates catheter removal, which is an endpoint in itself. Some studies defined treatment failure as a need to change the antimicrobial agent or catheter removal. In contrast, other studies defined primary failure as ongoing symptoms beyond 48 hours of antibiotic therapy, with catheter removal evaluated as a separate outcome. These factors reduced the comparability of studies.

 

Potential biases in the review process

While the review was completed according to standardised Cochrane methodology, potential biases in the review process should be considered. We completed a formal search designed by a specialist information manager including data from a wide range of sources, including handsearching, to limit the potential for omission of potentially relevant studies, although there is a possibility that relevant studies may have not been included. There were insufficient studies included in most meta-analyses to enable us to examine for potential publication bias. Most studies did not systematically report all relevant patient-centred outcomes, suggesting that data for mortality and other clinical outcomes were incomplete, and summary estimates were potentially unreliable.

 

Agreements and disagreements with other studies or reviews

As far as we are aware, this remains the only published systematic review of RCTs of all PD-associated peritonitis treatment. A review of antimicrobial treatment of PD-associated peritonitis published in 1991 concluded that the optimal empirical treatment was weekly vancomycin in combination with ceftazidime (Millikin 1991). However, this review predated many of the studies included in this study, and was not confined to RCTs.

The mainstay of peritonitis treatment is timely administration of empirical antimicrobial agents that are likely to eradicate the most common causative agents. This is endorsed by guidelines of the International Society of Peritoneal Dialysis (ISPD) (Li 2010) and the Australian and New Zealand Society of Nephrology (Caring for Australians with Renal Impairment - CARI, CARI 2005), both of which state that broad spectrum antibiotic agents designed to cover both gram negative and gram positive organisms should be initiated at the time a diagnosis of peritonitis is suspected. There is, however, insufficient evidence to suggest more specific agents. This has been demonstrated by this review in which we found that in 21 studies comparing different antibiotic classes, the treatment failure rates were generally in the range of 10% to 30%, with only three studies showing a difference between treatment arms (de Fijter 2001; Flanigan 1991; Lupo 1997). In each of these cases the applicability to current practice is low. de Fijter 2001 found IP ciprofloxacin and rifampicin to be superior to IP cephradine. However, monotherapy with a first generation cephalosporin is uncommon, and in this case, was associated with a low initial response rate of 50%. Furthermore, the broad spectrum of action of both ciprofloxacin and rifampicin predisposes to emergence of multiresistant organisms thereby reducing their desirability as first line agents. In our meta-analysis of two studies comparing IP cephazolin and vancomycin we found vancomycin to be superior. However, this result was strongly influenced by a larger number of patients in Flanigan 1991, in which the cephazolin dose of 50 mg/L was two and a half times less than that recommended in the current ISPD guidelines (Li 2010).

Similar efficacy rates amongst several antibiotic regimens facilitate consideration of logistical factors and adverse effect profiles when selecting antibiotics (Kan 2003). Current ISPD guidelines state that there should be centre-specific selection of agents according to local causative micro-organism and resistance patterns (Li 2010). The impact of local microbial resistance on peritonitis outcomes was apparent in two studies comparing oral and IP quinolone use (Cheng 1993; Cheng 1997). In these studies, response rates were low for both treatment arms (41.7% and 55.6% in the oral groups and 66.7% and 70.6% in the IP groups respectively). Micro-organism resistance to quinolones was the major cause of treatment failure, and previous exposure to quinolones was a risk factor for infection with resistant micro-organisms. The emergence of vancomycin-resistant enterococcus is also associated with use of broad spectrum antibiotics (Carmeli 2002; Oprea 2004). Of note increasing prevalence of methicillin-resistant Staphylococci (both S. aureus and coagulase negative species) is a relatively recent phenomenon hence limiting the ability of early studies to evaluate this problem.

In this review, we found that studies in which antibiotics (ciprofloxacin, ofloxacin and cephradine) were administered either orally or IP showed no difference in outcomes for the two routes of administration. However, initial antibiotic therapy is commonly administered intraperitoneally as this theoretically achieves higher dialysate antibiotic levels than permitted with other routes. Evidence about the relative importance of dialysate antibiotic levels was unclear (reviewed in Johnson 2011). In the study of oral versus IP ciprofloxacin included in this review, dialysate antibiotic levels were lower in the IP group but this did not affect patient outcomes (Cheng 1993). Booranalertpaisarn 2003 reported that daily dosing of ceftazidime in patients with peritonitis led to serum levels that were above the recommended minimum inhibitory concentration (MIC) throughout 24 hours, whereas dialysate levels were below the MIC for several hours on days one and four. Despite this, the response rate was 90%, suggesting that achieving therapeutic dialysate levels may not be necessary for treatment to be effective.

Benefits of intermittent (daily) dosing of antibiotics include facilitation of outpatient management and continuation of APD. In the general population, daily dosing with aminoglycosides reduces the risk of ototoxicity compared with intermittent dosing (Deamer 1996). In this review, intermittent and continuous antibiotic dosing had similar outcomes. Adequate duration of antibiotic activity with daily dosing is facilitated by long drug half-lives. Studies of CAPD patients without peritonitis have shown that serum and dialysate levels of several antibiotics remain above the mean inhibitory concentration for up to 48 hours (Grabe 1999; Manley 1999). Many drugs have peak serum levels six hours after administration suggesting that this should be the minimum dwell time. Post-antibiotic effects of drugs may also contribute to the efficacy of intermittent dosing. The applicability of results from studies of intermittent drug therapy in CAPD to APD is however unclear as drug half-lives are greater and clearances more rapid in cycler dwells compared to non-cycler dwells (Manley 2002).

The high rate of complications arising from peritonitis despite rapid institution of antibiotic therapy suggests a need exists for adjuvant treatment strategies. One such treatment is administration of IP urokinase, the rationale being to dissolve fibrin and enable access of antibiotics to entrapped bacteria (Pickering 1989). Williams 1989 showed that urokinase was inferior to simultaneous catheter removal and replacement. However, catheter removal could in itself be considered treatment failure. Meta-analysis of three other studies showed no statistically significant difference in outcomes between urokinase and catheter removal. However, it is noteworthy that in Tong 2005a, the actual number of patients achieving a primary response was five more in the urokinase than the control group, and there were three fewer catheter removals. Furthermore, adequately powered, studies in this area may be beneficial, in which the optimal outcome would be permanent transfer to haemodialysis.

Peritoneal lavage is performed at many centres because it has the potential to remove inflammatory cells and micro-organisms from the peritoneal cavity while providing symptomatic relief, and has been used successfully in abdominal surgery (O'Brien 1987). It has however been the subject of only one RCT (Ejlersen 1991), in which patients with hypotension and shock, the same group in which lavage has been used in surgical settings, were excluded. In this study, peritoneal lavage did not improve response rates. This may be a true effect due to inadvertent removal of macrophages and other components of the immune system thereby a reduction of local host defences against infection. However, further studies to evaluate this therapy further may be useful.

A novel strategy is administration of IP immunoglobulin in conjunction with antibiotics with the aim of improving local host defences (Carozzi 1988). In a study of 24 patients (Coban 2004) biochemical and clinical parameters of improvement were achieved sooner, and the duration of antibiotic therapy was shorter in the immunoglobulin treatment group. The response rate of 100% was unusually high and there were no relapses during three months of follow-up. In a larger population, a difference in response rates may have become apparent.

 

Authors' conclusions

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

 

Implications for practice

In conclusion, currently available evidence from RCTs is not robust and does not identify an optimal antibiotic regimen for the treatment of PD-associated peritonitis.

  • Available studies are small, and generally at high risk of bias, lowering the certainty of treatment effects for all available treatments.
  • At the present time, broad spectrum antibiotics should be initiated at the time a diagnosis of peritonitis is made and IP routes and use of glycopeptides may improve outcomes.
  • Intermittent antibiotic dosing appears to be as effective as continuous dosing, however, the applicability of this practice to APD is unclear.
  • There appears to be no role for adjunctive therapies such as urokinase and peritoneal lavage.
  • When choosing antibiotics, the side-effect profile, local drug resistance patterns and previous antibiotic use and infection history in the individual concerned should be considered. Oral antibiotics may increase risks of nausea and vomiting compared with IP administration.
  • IP route of administration may be superior to IV dosing in preventing primary treatment failures.
  • Few data were available on the pharmacokinetics of many commonly used antibiotics when administered intraperitoneally, and information about many new antibiotics is lacking. Data for automated PD were scant.
  • In cases of recurrent peritonitis, dialysis catheters should be removed rather than using IP urokinase.

Currently available evidence from RCTs is inadequate in many areas of clinical practice important in the management of PD-associated peritonitis and is a limiting factor in the provision of definitive treatment guidelines.

 
Implications for research

Future research should be adequately powered to assess outcomes such as catheter removal and mortality, and should include long-term follow-up of parameters such as ultrafiltration failure, loss of residual kidney function and technique failure.

Further studies are needed to:

  • Establish the most effective treatment for PD-associated peritonitis. An essential feature of such studies is inclusion of enough patients to ensure adequate power to assess meaningful long- and short-term outcomes. Short-term outcomes should extend beyond whether cure is achieved without catheter removal, for example duration of systemic inflammation. Study of long-term outcomes should include permanent transfer to haemodialysis, development of ultrafiltration failure patient death and late recurrent episodes of peritonitis beyond four weeks from the original episode.
  • Identify specific interventions that would be of value including early versus late catheter removal. Studies designed to study infections due to specific organisms would also be valuable. An example is a study of glycopeptide versus cephalosporin therapy in peritonitis due to coagulase negative Staphylococcal species. Most studies have included patients on CAPD rather than APD, hence, studies designed to test the efficacy of antibiotics in APD are required. This is particularly applicable to studies of intermittent versus continuous dosing when cycler dwell times may well influence pharmacokinetics. Additional studies including greater numbers of participants comparing IP versus IV dosing of the same antibiotic would also assist in assessing meaningful treatment effects.

In addition, future research should be conducted using standard definitions, with inclusion of information about factors that may influence the response to therapy such as prophylaxis regimens and dialysis solutions used. Current ISPD guidelines provide a comprehensive list of requirements for future studies that should be referred to when designing studies.

 

Acknowledgements

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

We would like to thank the referees for their comments and feedback during the preparation of this review.

We would like to thank Narelle Willis and Ruth Mitchell from the Cochrane Renal Group for their assistance to update this review.

We would also like to thank Dr Martin Searle from the Department of Nephrology at Christchurch Hospital for his contribution to the updated review.

 

Data and analyses

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
Download statistical data

 
Comparison 1. Intravenous (IV) versus intraperitoneal (IP) antibiotics

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Primary treatment failure2Risk Ratio (M-H, Random, 95% CI)Totals not selected

    1.1 Vancomycin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    1.2 Vancomycin and tobramycin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 2 Adverse events2Risk Ratio (M-H, Random, 95% CI)Totals not selected

    2.1 Rash
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    2.2 Hypotension
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 3 Infusion pain1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 
Comparison 2. Oral versus intraperitoneal (IP) antibiotics (same antibiotic)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Primary treatment failure283Risk Ratio (M-H, Random, 95% CI)1.34 [0.71, 2.56]

 2 Relapse283Risk Ratio (M-H, Random, 95% CI)3.38 [0.74, 15.35]

 3 Failure to achieve complete cure283Risk Ratio (M-H, Random, 95% CI)1.66 [0.98, 2.83]

 4 Catheter removal1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 5 Hospitalisation rate1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 6 Adverse events1Risk Ratio (M-H, Random, 95% CI)Totals not selected

    6.1 Nausea and vomiting
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 
Comparison 3. Oral versus intraperitoneal (IP) antibiotics (different antibiotics)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Failure to achieve complete cure8510Risk Ratio (M-H, Random, 95% CI)1.06 [0.80, 1.40]

    1.1 Oral quinolone versus aminoglycoside/glycopeptide (IP)
5304Risk Ratio (M-H, Random, 95% CI)1.19 [0.83, 1.72]

    1.2 Oral quinolone versus cephalosporin (IP)
2148Risk Ratio (M-H, Random, 95% CI)1.00 [0.55, 1.81]

    1.3 Oral cephradine versus cefuroxime (IP)
158Risk Ratio (M-H, Random, 95% CI)0.77 [0.40, 1.46]

 2 Primary treatment failure7472Risk Ratio (M-H, Random, 95% CI)1.04 [0.68, 1.59]

    2.1 Oral quinolone versus aminoglycoside/glycopeptide (IP)
5304Risk Ratio (M-H, Random, 95% CI)1.13 [0.66, 1.94]

    2.2 Oral quinolone versus cephalosporin (IP)
1110Risk Ratio (M-H, Random, 95% CI)1.04 [0.47, 2.33]

    2.3 Oral cephradine versus cefuroxime (IP)
158Risk Ratio (M-H, Random, 95% CI)0.6 [0.16, 2.28]

 3 Relapse5304Risk Ratio (M-H, Random, 95% CI)1.17 [0.64, 2.15]

 4 Catheter removal2170Risk Ratio (M-H, Random, 95% CI)1.18 [0.49, 2.87]

 5 Hospitalisation rate1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 6 All-cause mortality1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 7 Microbiological eradication1Risk Ratio (M-H, Random, 95% CI)Totals not selected

    7.1 Oral quinolone versus aminoglycoside/glycopeptide (IP)
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 8 Adverse events3Risk Ratio (M-H, Random, 95% CI)Subtotals only

    8.1 Nausea/vomiting (oral quinolone versus aminoglycoside/glycopeptide (IP))
3158Risk Ratio (M-H, Random, 95% CI)9.91 [1.89, 51.99]

    8.2 Abdominal swelling or pseudo-obstruction
160Risk Ratio (M-H, Random, 95% CI)1.0 [0.07, 15.26]

    8.3 Hypotension
160Risk Ratio (M-H, Random, 95% CI)0.33 [0.01, 7.87]

    8.4 Lethargy
150Risk Ratio (M-H, Random, 95% CI)3.0 [0.13, 70.30]

    8.5 Myalgia
150Risk Ratio (M-H, Random, 95% CI)3.0 [0.13, 70.30]

 
Comparison 4. Any oral versus any intraperitoneal (IP)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Treatment failure9555Risk Ratio (M-H, Random, 95% CI)1.12 [0.79, 1.60]

    1.1 Different
7472Risk Ratio (M-H, Random, 95% CI)1.04 [0.68, 1.59]

    1.2 Same
283Risk Ratio (M-H, Random, 95% CI)1.34 [0.71, 2.56]

 
Comparison 5. Low versus high dose antibiotic

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Failure to achieve complete cure1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 2 Relapse1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 3 Seizures1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 
Comparison 6. Intermittent versus continuous antibiotics

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Failure to achieve complete cure4338Risk Ratio (M-H, Random, 95% CI)0.92 [0.64, 1.33]

    1.1 Gentamicin
1100Risk Ratio (M-H, Random, 95% CI)0.79 [0.45, 1.37]

    1.2 Vancomycin
272Risk Ratio (M-H, Random, 95% CI)0.62 [0.18, 2.11]

    1.3 Tecioplanin/ceftazidime
186Risk Ratio (M-H, Random, 95% CI)1.23 [0.53, 2.90]

    1.4 Vancomycin/ceftazidime
180Risk Ratio (M-H, Random, 95% CI)1.09 [0.55, 2.18]

 2 Primary treatment failure5522Risk Ratio (M-H, Random, 95% CI)1.11 [0.77, 1.62]

    2.1 Gentamicin
1100Risk Ratio (M-H, Random, 95% CI)0.67 [0.26, 1.73]

    2.2 Vancomycin
272Risk Ratio (M-H, Random, 95% CI)1.1 [0.08, 15.36]

    2.3 Teicoplanin/ceftazidime
186Risk Ratio (M-H, Random, 95% CI)4.39 [0.51, 37.69]

    2.4 Vancomycin/ceftazidime
180Risk Ratio (M-H, Random, 95% CI)1.6 [0.57, 4.47]

    2.5 Cefazolin/tobramycin
1184Risk Ratio (M-H, Random, 95% CI)1.10 [0.70, 1.73]

 3 Relapse4338Risk Ratio (M-H, Random, 95% CI)0.76 [0.45, 1.28]

    3.1 Gentamicin
1100Risk Ratio (M-H, Random, 95% CI)0.9 [0.40, 2.02]

    3.2 Vancomycin
272Risk Ratio (M-H, Random, 95% CI)0.53 [0.13, 2.11]

    3.3 Teicoplanin/ceftazidime
186Risk Ratio (M-H, Random, 95% CI)0.78 [0.27, 2.28]

    3.4 Vancomycin/ceftazidime
180Risk Ratio (M-H, Random, 95% CI)0.67 [0.20, 2.18]

 4 Catheter removal1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 5 Rash1Risk Ratio (M-H, Random, 95% CI)Totals not selected

    5.1 Vancomycin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 
Comparison 7. First generation cephalosporin versus glycopeptide-based intraperitoneal (IP) antibiotic regimen

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Failure to achieve complete cure3370Risk Ratio (M-H, Random, 95% CI)1.66 [1.01, 2.72]

    1.1 Vancomycin-based regimen
2305Risk Ratio (M-H, Random, 95% CI)1.51 [1.03, 2.22]

    1.2 Teicoplanin-based regimen
165Risk Ratio (M-H, Random, 95% CI)4.63 [1.04, 20.58]

 2 Primary treatment failure2Risk Ratio (M-H, Random, 95% CI)Subtotals only

    2.1 Vancomycin-based regimen
2305Risk Ratio (M-H, Random, 95% CI)1.14 [0.69, 1.87]

 3 Relapse3350Risk Ratio (M-H, Random, 95% CI)1.68 [0.84, 3.36]

    3.1 Vancomycin-based regimen
2305Risk Ratio (M-H, Random, 95% CI)1.62 [0.69, 3.79]

    3.2 Teicoplanin-based regimen
145Risk Ratio (M-H, Random, 95% CI)1.37 [0.09, 20.52]

 4 Catheter removal2305Risk Ratio (M-H, Random, 95% CI)0.95 [0.41, 2.19]

 5 Microbiological eradication1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 
Comparison 8. Teicoplanin versus vancomycin-based intraperitoneal (IP) antibiotic regimen

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Primary treatment failure2178Risk Ratio (M-H, Random, 95% CI)0.36 [0.13, 0.96]

 2 Failure to achieve complete cure2178Risk Ratio (M-H, Random, 95% CI)0.67 [0.40, 1.15]

 3 Relapse2178Risk Ratio (M-H, Random, 95% CI)1.01 [0.49, 2.11]

 
Comparison 9. Comparison of two oral antibiotic regimens

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Failure to achieve complete cure1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 2 Catheter removal1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 3 Change in antibiotics following culture results1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 4 Adverse events1Risk Ratio (M-H, Random, 95% CI)Totals not selected

    4.1 Nausea and vomiting
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    4.2 Rash
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 
Comparison 10. Fibrinolytic agents versus non-urokinase or placebo

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Failure to achieve complete cure1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 2 Primary treatment failure (persistent peritonitis)299Risk Ratio (M-H, Random, 95% CI)0.63 [0.32, 1.26]

 3 Relapse3Risk Ratio (M-H, Random, 95% CI)Subtotals only

    3.1 Persistent peritonitis
2101Risk Ratio (M-H, Random, 95% CI)0.51 [0.22, 1.17]

    3.2 Peritonitis commencement
180Risk Ratio (M-H, Random, 95% CI)1.33 [0.32, 5.58]

 4 Catheter removal2168Risk Ratio (M-H, Random, 95% CI)0.70 [0.37, 1.30]

    4.1 Persistent peritonitis
188Risk Ratio (M-H, Random, 95% CI)0.77 [0.38, 1.57]

    4.2 Peritonitis commencement
180Risk Ratio (M-H, Random, 95% CI)0.5 [0.13, 1.86]

 5 All-cause mortality1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 
Comparison 11. Urokinase versus simultaneous catheter removal or replacement

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Recurrence of peritonitis1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 
Comparison 12. Peritoneal lavage

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Failure to achieve complete cure1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 2 Relapse1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 3 Technique failure1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 4 Adverse events1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 
Comparison 13. Intraperitoneal immunoglobulin

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Number of exchanges for reduction in dialysate WWC < 100/mL1Mean Difference (IV, Random, 95% CI)Totals not selected

 2 Relapse1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 
Comparison 14. Comparison of two intraperitoneal antibiotic regimens

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Failure to achieve complete cure6Risk Ratio (M-H, Random, 95% CI)Totals not selected

    1.1 Cefepime versus vancomycin/netilmicin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    1.2 Cefuroxime verus vancomycin/netilmicin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    1.3 Vancomycin/cefotaxime versus/tobramycin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    1.4 Ciproflozacin verus vancomycin/gentamicin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    1.5 Cefazolin/ceftazidime versus cefazolin/netilmicin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    1.6 Cefapime versus cefotaxime
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 2 Primary treatment failure8Risk Ratio (M-H, Random, 95% CI)Totals not selected

    2.1 Cefepime versus vancomycin/netilmicin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    2.2 Vancomycin/cefotaxime versus/tobramycin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    2.3 Ciproflozacin verus vancomycin/gentamicin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    2.4 Cephazolin/netilmicin versus vancomycin/ceftazidine
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    2.5 Cefuroxime versus teicoplanin/aztreonam
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    2.6 Cefazolin/ceftazidime versus imipenem
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    2.7 Ceiprofloxacin/rifampicin versus cephradine
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    2.8 Gentamicin/methicillin versus clindamycin/mezlocillin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    2.9 Gentamicin/methicillin versus gentamicin/cloxacillin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    2.10 Gentamicin/cloxacillin verus clindamycin/mezlocillin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 3 Relapse6Risk Ratio (M-H, Random, 95% CI)Totals not selected

    3.1 Cefepime versus vancomycin/netilmicin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    3.2 Vancomycin/cefotaxime versus/tobramycin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    3.3 Ciproflozacin verus vancomycin/gentamicin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    3.4 Cefuroxime versus teicoplanin/aztreonam
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    3.5 Cefazolin/ceftazidime versus cefazolin/netilmicin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    3.6 Ceiprofloxacin/rifampicin versus cephradine
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 4 Death due to peritonitis1Risk Ratio (M-H, Random, 95% CI)Totals not selected

    4.1 Cefepime versus vancomycin/netilmicin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 5 Hospitalisation rate1Risk Ratio (M-H, Random, 95% CI)Totals not selected

    5.1 Cefepime versus vancomycin/netilmicin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 6 Infusion pain1Risk Ratio (M-H, Random, 95% CI)Totals not selected

    6.1 Cefepime versus vancomycin/netilmicin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 7 Catheter removal6Risk Ratio (M-H, Random, 95% CI)Totals not selected

    7.1 Cefuroxime verus vancomycin/netilmicin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    7.2 Vancomycin/cefotaxime versus/tobramycin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    7.3 Ciproflozacin verus vancomycin/gentamicin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    7.4 Cefazolin/ceftazidime versus imipenem
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    7.5 Cefazolin/ceftazidime versus cefazolin/netilmicin
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    7.6 Ceiprofloxacin/rifampicin versus cephradine
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 8 All-cause mortality1Risk Ratio (M-H, Random, 95% CI)Totals not selected

    8.1 Cefuroxime versus teicoplanin/aztreonam
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 9 Microbiological eradication1Risk Ratio (M-H, Random, 95% CI)Totals not selected

    9.1 Ceiprofloxacin/rifampicin versus cephradine
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 10 Adverse events1Risk Ratio (M-H, Random, 95% CI)Totals not selected

    10.1 Gastrointestinal toxicity
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

    10.2 Rash
1Risk Ratio (M-H, Random, 95% CI)0.0 [0.0, 0.0]

 
Comparison 15. Intravenous (IV) vancomycin and dialysate gentamicin: 21 days versus 10 days

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Relapse1Risk Ratio (M-H, Random, 95% CI)Totals not selected

 

Appendices

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
 

Appendix 1. Electronic search strategies


DatabaseSearch terms

CENTRAL#1 PERITONEAL DIALYSIS
#2 (peritoneal next dialysis)
#3 pd
#4 capd
#5 ccpd
#6 (#1 or #2 or #3 or #4 or #5)
#7 PERITONITIS
#8 peritonitis
#9 periton*
#10 infect*
#11 (#9 and #10)
#12 PERITONEUM
#13 BACTERIAL INFECTIONS AND MYCOSES
#14 (#12 and #13)
#15 (#7 or #8 or #11 or #14)
#16 (#6 and #15)

MEDLINE1. exp peritoneal dialysis/
2. peritoneal dialysis.tw.
3. (PD or CAPD or CCPD).tw.
4. or/1-3
5. Peritonitis/
6. peritonitis.tw.
7. (periton$ and infect$).tw.
8. exp Peritoneum/
9. exp "bacterial infections and mycoses"/
10. 8 and 9
11. or/5-7,10
12. 4 and 11

EMBASE1. continuous ambulatory peritoneal dialysis/ or peritoneal dialysis/
2. peritoneal dialysis.tw.
3. (PD or CAPD or CCPD).tw.
4. or/1-3
5. exp Peritonitis/
6. peritonitis.tw.
7. (periton$ and infect$).tw.
8. exp peritoneal cavity/ or exp peritoneum/
9. exp Infection/
10. 8 and 9
11. or/5-7,10
12. 4 and 11



 

Appendix 2. Risk of bias assessment tool


Potential source of biasAssessment criteria

Random sequence generation

Selection bias (biased allocation to interventions) due to inadequate generation of a randomised sequence
Low risk of bias: Random number table; computer random number generator; coin tossing; shuffling cards or envelopes; throwing dice; drawing of lots; minimization (minimization may be implemented without a random element, and this is considered to be equivalent to being random).

High risk of bias: Sequence generated by odd or even date of birth; date (or day) of admission; sequence generated by hospital or clinic record number; allocation by judgement of the clinician; by preference of the participant; based on the results of a laboratory test or a series of tests; by availability of the intervention.

Unclear: Insufficient information about the sequence generation process to permit judgement.

Allocation concealment

Selection bias (biased allocation to interventions) due to inadequate concealment of allocations prior to assignment
Low risk of bias: Randomisation method described that would not allow investigator/participant to know or influence intervention group before eligible participant entered in the study (e.g. central allocation, including telephone, web-based, and pharmacy-controlled, randomisation; sequentially numbered drug containers of identical appearance; sequentially numbered, opaque, sealed envelopes).

High risk of bias: Using an open random allocation schedule (e.g. a list of random numbers); assignment envelopes were used without appropriate safeguards (e.g. if envelopes were unsealed or non-opaque or not sequentially numbered); alternation or rotation; date of birth; case record number; any other explicitly unconcealed procedure.

Unclear: Randomisation stated but no information on method used is available.

Blinding of participants and personnel

Performance bias due to knowledge of the allocated interventions by participants and personnel during the study
Low risk of bias: No blinding or incomplete blinding, but the review authors judge that the outcome is not likely to be influenced by lack of blinding; blinding of participants and key study personnel ensured, and unlikely that the blinding could have been broken.

High risk of bias: No blinding or incomplete blinding, and the outcome is likely to be influenced by lack of blinding; blinding of key study participants and personnel attempted, but likely that the blinding could have been broken, and the outcome is likely to be influenced by lack of blinding.

Unclear: Insufficient information to permit judgement

Blinding of outcome assessment

Detection bias due to knowledge of the allocated interventions by outcome assessors.
Low risk of bias: No blinding of outcome assessment, but the review authors judge that the outcome measurement is not likely to be influenced by lack of blinding; blinding of outcome assessment ensured, and unlikely that the blinding could have been broken.

High risk of bias: No blinding of outcome assessment, and the outcome measurement is likely to be influenced by lack of blinding; blinding of outcome assessment, but likely that the blinding could have been broken, and the outcome measurement is likely to be influenced by lack of blinding.

Unclear: Insufficient information to permit judgement

Incomplete outcome data

Attrition bias due to amount, nature or handling of incomplete outcome data.
Low risk of bias: No missing outcome data; reasons for missing outcome data unlikely to be related to true outcome (for survival data, censoring unlikely to be introducing bias); missing outcome data balanced in numbers across intervention groups, with similar reasons for missing data across groups; for dichotomous outcome data, the proportion of missing outcomes compared with observed event risk not enough to have a clinically relevant impact on the intervention effect estimate; for continuous outcome data, plausible effect size (difference in means or standardized difference in means) among missing outcomes not enough to have a clinically relevant impact on observed effect size; missing data have been imputed using appropriate methods.

High risk of bias: Reason for missing outcome data likely to be related to true outcome, with either imbalance in numbers or reasons for missing data across intervention groups; for dichotomous outcome data, the proportion of missing outcomes compared with observed event risk enough to induce clinically relevant bias in intervention effect estimate; for continuous outcome data, plausible effect size (difference in means or standardized difference in means) among missing outcomes enough to induce clinically relevant bias in observed effect size; ‘as-treated’ analysis done with substantial departure of the intervention received from that assigned at randomisation; potentially inappropriate application of simple imputation.

Unclear: Insufficient information to permit judgement

Selective reporting

Reporting bias due to selective outcome reporting
Low risk of bias: The study protocol is available and all of the study’s pre-specified (primary and secondary) outcomes that are of interest in the review have been reported in the pre-specified way; the study protocol is not available but it is clear that the published reports include all expected outcomes, including those that were pre-specified (convincing text of this nature may be uncommon).

High risk of bias: Not all of the study’s pre-specified primary outcomes have been reported; one or more primary outcomes is reported using measurements, analysis methods or subsets of the data (e.g. subscales) that were not pre-specified; one or more reported primary outcomes were not pre-specified (unless clear justification for their reporting is provided, such as an unexpected adverse effect); one or more outcomes of interest in the review are reported incompletely so that they cannot be entered in a meta-analysis; the study report fails to include results for a key outcome that would be expected to have been reported for such a study.

Unclear: Insufficient information to permit judgement

Other bias

Bias due to problems not covered elsewhere in the table
Low risk of bias: The study appears to be free of other sources of bias.

High risk of bias: Had a potential source of bias related to the specific study design used; stopped early due to some data-dependent process (including a formal-stopping rule); had extreme baseline imbalance; has been claimed to have been fraudulent; had some other problem.

Unclear: Insufficient information to assess whether an important risk of bias exists; insufficient rationale or evidence that an identified problem will introduce bias.



 

What's new

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

Last assessed as up-to-date: 5 March 2014.


DateEventDescription

2 May 2014AmendedMinor copy edits made to study names to match Renal Group's Specialised Register



 

History

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

Protocol first published: Issue 2, 2005
Review first published: Issue 1, 2008


DateEventDescription

5 March 2014New search has been performedReview updated

5 March 2014New citation required and conclusions have changedNew studies identified

11 June 2008AmendedConverted to new review format.



 

Contributions of authors

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

Screening of titles and abstracts: AB, KW, GFMS, SP
Study eligibility: AB, KW, GFMS, SP
Risk of bias assessment, data extraction, data analysis: AB, KW, GFMS, SP
Writing of review: AB, KW, GFMS, SP, DJ, JC
Disagreement resolution: DJ, JC

 

Declarations of interest

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

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.

 

Sources of support

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
 

Internal sources

  • The research team acknowledges the support received from the Cochrane Renal Group in the conduct of this review, Australia.

 

External sources

  • Suetonia Palmer, New Zealand.
    received an unrestricted fellowship from Amgen Dompe, administered by the Consorzio Mario Negri Sud
  • Angela Ballinger, New Zealand.
    Received a summer student scholarship from the Division of Medical Sciences, Unversity of Otago to complete the update of this review

* Indicates the major publication for the study

References

References to studies included in this review

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Characteristics of studies
  18. References to studies included in this review
  19. References to studies excluded from this review
  20. References to ongoing studies
  21. Additional references
  22. References to other published versions of this review
Altmann 1984 {published data only}
  • Altmann P, Butter K, Cunningham J, Drew P, Goodwin F, Marsh F. CAPD peritonitis: 10 or 21 days treatment? [abstract]. Kidney International 1984;26(4):544.
Bailie 1987 {published data only}
  • Bailie GR, Morton R, Ganguli L, Keaney M, Waldek S. Intravenous or intraperitoneal vancomycin for the treatment of continuous ambulatory peritoneal dialysis associated gram-positive peritonitis?. Nephron 1987;46(3):316-8. [MEDLINE: 3627326]
Bennett-Jones 1987 {published data only}
  • Bennett-Jones D, Wass V, Mawson P. A comparison of intraperitoneal and intravenous/oral antibiotics in CAPD peritonitis. Peritoneal Dialysis Bulletin 1987;7(1):31-3. [EMBASE: 1987123371]
  • Bennett-Jones DN, Eaton A, Taube D, Wass V, Mawson P, Neild GH, et al. A trial of intraperitoneal versus intravenous antibiotics in the treatment of CAPD peritonitis [abstract]. Kidney International 1984;26(4):538. [CENTRAL: CN-00602030]
Bennett-Jones 1990 {published data only}
  • Bennett-Jones DN, Russell GI, Barrett A. A comparison between oral ciprofloxacin and intra-peritoneal vancomycin and gentamicin in the treatment of CAPD peritonitis. Journal of Antimicrobial Chemotherapy 1990;26 Suppl F:73-6. [MEDLINE: 2292547]
Boeschoten 1985 {published data only}
  • Boeschoten EW, Rietra PJ, Krediet RT, Visser MJ, Arisz L. CAPD peritonitis: A prospective randomized trial of oral versus intraperitoneal treatment with cephradine. Journal of Antimicrobial Chemotherapy 1985;16(6):789-97. [MEDLINE: 3912367]
Bowley 1988 {published data only}
  • Bowley JA, Pickering SJ, Scantlebury AJ, Ackrill P, Jones DM. Intraperitoneal teicoplanin in the treatment of peritonitis associated with continuous ambulatory peritoneal dialysis. Journal of Antimicrobial Chemotherapy 1988;21 Suppl A:133-9. [MEDLINE: 2965125]
Boyce 1988 {published data only}
  • Boyce NW, Wood C, Thomson NM, Hooke D, Holdworth SR, Kerr P, et al. Intraperitoneal (IP) vancomycin therapy for CAPD peritonitis - a prospective controlled trial of intermittent vs continuous IP administration [abstract]. Kidney International 1988;33(1):136. [CENTRAL: CN-00444512]
  • Boyce NW, Wood C, Thomson NM, Kerr P, Atkins RC. Intraperitoneal (IP) vancomycin therapy for CAPD peritonitis - a prospective, randomized comparison of intermittent v continuous therapy. American Journal of Kidney Diseases 1988;12(4):304-6. [MEDLINE: 3177373]
  • Munro B. "Single dose" vancomycin treatment of continuous ambulatory peritoneal dialysis (CAPD) peritonitis. Renal Education 1987;7(3):45-7. [CENTRAL: CN-00636131]
Chan 1990 {published data only}
  • Chan MK, Cheng IK, Ng WS. A randomized prospective trial of three different regimens of treatment of peritonitis in patients on continuous ambulatory peritoneal dialysis. American Journal of Kidney Diseases 1990;15(2):155-9. [MEDLINE: 2405653]
Cheng 1991 {published data only}
  • Cheng IK, Chan CY, Wong WT. A randomised prospective comparison of oral ofloxacin and intraperitoneal vancomycin plus aztreonam in the treatment of bacterial peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD). Peritoneal Dialysis International 1991;11(1):27-30. [MEDLINE: 2049419]
Cheng 1993 {published data only}
  • Cheng IK, Chan CY, Wong WT, Cheng SW, Ritchie CW, Cheung WC, et al. A randomized prospective comparison of oral versus intraperitoneal ciprofloxacin as the primary treatment of peritonitis complicating continuous ambulatory peritoneal dialysis. Peritoneal Dialysis International 1993;13 Suppl 2:S351-4. [MEDLINE: 8399609]
Cheng 1997 {published data only}
  • Cheng IK, Lui SL, Fang GX, Chau PY, Cheng SW, Chiu FH, et al. A randomized prospective comparison of oral versus intraperitoneal ofloxacin as the primary treatment of CADP peritonitis. Nephrology 1997;3(5):431-5. [EMBASE: 1997337788]
  • Fang GX, Lo WX, Chan TM, Chau PY, Choy BY, Lo CY, et al. A randomised prospective comparison of oral versus intraperitoneal ofloxacin as primary treatment of bacterial peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD) [abstract]. 6th Asian Pacific Congress of Nephrology; 1995 Dec 5-9; Hong Kong. 1995:126.
Cheng 1998 {published data only}
  • Cheng IK, Chau PY, Chan TM, Wong A, Tong KL, Li CS, et al. A multicentre randomised prospective comparison of oral levofloxacin plus i.p. vancomycin and i.p. netromycin plus i.p. vancomycin as primary treatment of CAPD peritonitis [abstract]. Nephrology 1997;3(Suppl 1):S433. [CENTRAL: CN-00550585]
  • Cheng IK, Fang GX, Chau PY, Chan TM, Tong KL, Wong AK, et al. A randomized prospective comparison of oral levofloxacin plus intraperitoneal (IP) vancomycin and IP netromycin plus IP vancomycin as primary treatment of peritonitis complicating CAPD. Peritoneal Dialysis International 1998;18(4):371-5. [MEDLINE: 10505557]
Choy 2001 {published data only}
  • Choy BY, Lo WK, Chan TM, Lui SL, Tang S, Lam MF, et al. A randomised prospective comparison of intermittent versus continuous dosing regimens of intraperitoneal cefazolin and tobramycin in the treatment of CAPD peritonitis [abstract]. Journal of the American Society of Nephrology 2001;12(Program & Abstracts):425A. [CENTRAL: CN-00550719]
Coban 2004 {published data only}
  • Coban E, Ozdogan M, Tuncer M, Bozcuk H, Ersoy F. The value of low-dose intraperitoneal immunoglobulin administration in the treatment of peritoneal dialysis-related peritonitis. Journal of Nephrology 2004;17(3):427-30. [MEDLINE: 15365965]
de Fijter 2001 {published data only}
  • de Fijter CW, ter Wee PM, Oe LP, Verbrugh HA. Intraperitoneal ciprofloxacin and rifampicin versus cephradine as initial treatment of (C)APD-related peritonitis: a prospective randomized multicenter comparison (CIPPER trial). Peritoneal Dialysis International 2001;21(5):480-6. [MEDLINE: 11757832]
Drinovec 1988 {published data only}
  • Drinovec J, Bren A, Gucek A, Lindic J, Kandus A, Ponikvar R. The treatment of staphylococcus peritonitis in patients on continuous ambulatory peritoneal dialysis. Chemioterapia 1988;7(1):46-8. [MEDLINE: 3378276]
Ejlersen 1991 {published data only}
  • Ejlersen E, Brandi L, Lokkegaard H, Ladefoged J, Kopp R, Haarh P. Is initial (24 hours) lavage necessary in treatment of CAPD peritonitis?. Peritoneal Dialysis International 1991;11(1):38-42. [MEDLINE: 2049421]
Flanigan 1991 {published data only}
  • Flanigan MJ, Freeman RM, Lawton WJ. Vancomycin is superior to cefazolin for treatment of CAPD peritonitis [abstract]. Kidney International 1988;33(1):245.
  • Flanigan MJ, Lim VS. Initial treatment of dialysis associated peritonitis: A controlled trial of vancomycin versus cefazolin. Peritoneal Dialysis International 1991;11(1):31-7. [MEDLINE: 2049420]
Friedland 1990 {published data only}
  • Friedland JS, Iveson TJ, Fraise AP, Winearls CG, Selkon JB, Oliver DO. A comparison between intraperitoneal ciprofloxacin and intraperitoneal vancomycin and gentamicin in the treatment of peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). Journal of Antimicrobial Chemotherapy 1990;26 Suppl F:77-81. [MEDLINE: 2292548]
Gadallah 2000c {published data only}
  • Gadallah MF, Tamayo A, Sandborn M, Ramdeen G, Moles K. Role of intraperitoneal urokinase in acute peritonitis and prevention of catheter loss in peritoneal dialysis patients. Advances in Peritoneal Dialysis 2000;16:233-6. [MEDLINE: 11045301]
Gucek 1994 {published data only}
  • Gucek A, Bren AF, Lindic J, Hergouth V, Mlinsek D. Is monotherapy with cefazolin or ofloxacin an adequate treatment for peritonitis in CAPD patients?. Advances in Peritoneal Dialysis 1994;10:144-6. [MEDLINE: 7999813]
Gucek 1997 {published data only}
  • Gucek A, Bren AF, Hergouth V, Lindic J. Cefazolin and netilmycin versus vancomycin and ceftazidime in the treatment of CAPD peritonitis. Advances in Peritoneal Dialysis 1997;13:218-20. [MEDLINE: 9360685]
Hernandez 2004 {published data only}
  • Hernandez AG, Alvarez JG, Kiyono JK. Cefepime in the treatment of peritonitis associated with continuous ambulatory dialysis. Medicina Interna de Mexico 2004;20(3):173-82. [EMBASE: 2007502961]
Innes 1994 {published data only}
  • Innes A, Burden RP, Finch RG, Morgan AG. Treatment of resistant CAPD peritonitis with urokinase: a double-blind clinical trial [abstract]. Nephrology Dialysis Transplantation 1993;8(12):1408-9. [CENTRAL: CN-00465795]
  • Innes A, Burden RP, Finch RG, Morgan AG. Treatment of resistant peritonitis in continuous ambulatory peritoneal dialysis with intraperitoneal urokinase: a double-blind clinical trial. Nephrology Dialysis Transplantation 1994;9(7):797-9. [MEDLINE: 7970121]
Jiménez 1996 {published data only}
  • Jiménez C, Selgas R, Sánchez S, Bajo MA, Sánchez C, Díaz C, et al. Initial empiric treatment of peritonitis in CAPD with vancomycin + tobramycin vs. vancomycin + cefotaxime in a CAPD unit [Tratamiento empírico inicial de las peritonitis en DPCA con vancomicina + tobramicina vs. vancomicina + cefotaxima. estudio prospectivo randomizado en una unidad de DPCA]. Nefrología 1996;16(6):569. [CENTRAL: CN-00401408]
Khairullah 2002 {published data only}
  • Ahmad A, Khairullah Q, Provenzano R, Tayeb J, Balakrishnan R, Morrison L. Vancomycin (V) vs cefazolin (C) as initial therapy for peritonitis in peritoneal dialysis (PD) patients [abstract no: A1077]. Journal of the American Society of Nephrology 2000;11(Sept):202A-3A. [CENTRAL: CN-00550601]
  • Khairullah Q, Balakrishnan R, Provenzano R. Comparison of the efficacy of vancomycin vs cefazolin as initial therapy for peritonitis [abstract]. Journal of the American Society of Nephrology 1998;9(Program & Abstracts):284A-5A. [CENTRAL: CN-00446072]
  • Khairullah Q, Provenzano R, Tayeb J, Ahmad A, Balakrishnan R, Morrison L. Comparison of vancomycin versus cefazolin as initial therapy for peritonitis in peritoneal dialysis patients. Peritoneal Dialysis International 2002;22(3):339-44. [MEDLINE: 12227391]
Klaus 1995a {published data only}
  • Klaus G, Schaefer F, Muller-Wiefel D, Mehls O. Treatment of peritoneal dialysis-associated peritonitis with continuous versus intermittent vancomycin/teicoplanin and ceftazidime in children: preliminary results of a prospective randomized trial. Members of APN Arbeitsgemeinschaft Paidiatrische Nephrologie. Advances in Peritoneal Dialysis 1995;11:296-301. [MEDLINE: 8534728]
  • Schaefer F, Klaus G, Muller-Wiefel D, Mehls O, Mid European Study Group for Pediatric CAPD/CCPD. Continuous vs intermittent treatment of peritonitis in children on continuous peritoneal dialysis - results of a prospective randomized trial [abstract]. Pediatric Nephrology 1995;9(6):C45. [CENTRAL: CN-00509463]
  • Schaefer F, Klaus G, Muller-Wiefel DE, Mehls O. Intermittent versus continuous intraperitoneal glycopeptide/ceftazidime treatment in children with peritoneal dialysis-associated peritonitis. Journal of the American Society of Nephrology 1999;10(1):136-45. [MEDLINE: 9890319]
Leung 2004 {published data only}
  • Leung C, Szeto C, Chow K, Kwan BC, Wang AY, Lui S, et al. Cefazolin plus ceftazidime versus imipenem/cilastatin monotherapy for treatment of CAPD peritonitis - a randomized controlled trial. [abstract no: PUB392]. Journal of the American Society of Nephrology 2003;14(Nov):858A. [CENTRAL: CN-00626024]
  • Leung CB, Szeto CC, Chow KM, Kwan BC, Wang AY, Lui SF, et al. Cefazolin plus ceftazidime versus imipenem/cilastatin monotherapy for treatment of CAPD peritonitis--a randomized controlled trial. Peritoneal Dialysis International 2004;24(5):440-6. [MEDLINE: 15490983]
Lui 2005 {published data only}
  • Lui SL, Cheng SW, Ng F, Ng SY, Wan KM, Yip T, et al. Cefazolin plus netilmicin versus cefazolin plus ceftazidime for treating CAPD peritonitis: effect on residual renal function. Kidney International 2005;68(5):2375-80. [MEDLINE: 16221243]
  • Lui SL, Cheng SW, Ng F, Yip PS, Tse KC, Lam MF, et al. A randomized prospective comparison of intraperitoneal cefazolin plus netilmicin versus cefazolin plus ceftazidime in the treatment of CAPD peritonitis [abstract no: M-PO40056]. Nephrology 2005;10(Suppl 1):A68. [CENTRAL: CN-00626020]
Lupo 1997 {published data only}
  • Lupo A, Rugiu C, Bernich P, Laudon A, Marcantoni C, Mosconi G, et al. A prospective, randomized trial of two antibiotic regimens in the treatment of peritonitis in CAPD patients: teicoplanin plus tobramycin versus cephalothin plus tobramycin. Journal of Antimicrobial Chemotherapy 1997;40(5):729-32. [MEDLINE: 9421325]
Lye 1993 {published data only}
  • Lye WC, Lee EJ, van der Straaten J. Intraperitoneal vancomycin/oral pefloxacin versus intraperitoneal vancomycin/gentamicin in the treatment of continuous ambulatory peritoneal dialysis peritonitis. Peritoneal Dialysis International 1993;13 Suppl 2:S348-50. [MEDLINE: 8399607]
Lye 1995 {published data only}
  • Lye WC, Wong PL, Van der Straaten JC, Leong SO, Lee EJ. A prospective randomized comparison of single versus multidose gentamicin in the treatment of CAPD peritonitis. Advances in Peritoneal Dialysis 1995;11:179-81. [MEDLINE: 8534699]
Merchant 1992 {published data only}
  • Anwar N, Merchant M, Were T, Tooth A, Uttley L, Gokal R. A prospective, randomized study of the comparative safety and efficacy of intraperitoneal imipenem versus vancomycin and netilmicin in the treatment of peritonitis on CAPD. Peritoneal Dialysis International 1995;15(2):167-71. [MEDLINE: 7612739]
  • Merchant MR, Anwar N, Were A, Uttley L, Tooth JA, Gokal R. Imipenem versus netilmicin and vancomycin in the treatment of CAPD peritonitis. Advances in Peritoneal Dialysis 1992;8:234-7. [MEDLINE: 1361795]
Raman 1985 {published data only}
Tapson 1990 {published data only}
  • Tapson JS, Orr KE, George JC, Stansfield E, Bint AJ, Ward MK. A comparison between oral ciprofloxacin and intraperitoneal vancomycin and netilmicin in CAPD peritonitis. Journal of Antimicrobial Chemotherapy 1990;26 Suppl F:63-71. [MEDLINE: 2292546]
Tong 2005a {published data only}
  • Tong MK, Leung KT, Siu YP, Lee HK, Yung CY, Kwan TH, et al. Use of intraperitoneal urokinase for resistant bacterial peritonitis in continuous ambulatory peritoneal dialysis. Journal of Nephrology 2005;18(2):204-8. [MEDLINE: 15931649]
Vargemezis 1989 {published data only}
  • Vargemezis V, Pasadakis P, Thodis H, Coucudis P, Peihaberis P, Jafer H, et al. Vancomycin therapy for gram-positive peritonitis in patients on CAPD. Advances in Peritoneal Dialysis 1989;5:128-9. [MEDLINE: 2577394]
Velasquez-Jones 1995 {published data only}
  • Velasquez-Jones L, Sanchez-Aguilar JR, Castelares G, Rada-Cuentas J, Zavala-Lozano N, Tanaka J, et al. Efficacy of intraperitoneal vancomycin in children on continuous ambulatory peritoneal dialysis: comparison of intermittent and continuous therapy. Boletin Medico del Hospital Infantil de Mexico 1995;52(3):154-9. [EMBASE: 1995125387]
Wale 1992 {published data only}
  • 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}
  • 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]
  • 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: 1582059]
Williams 1989 {published data only}
  • 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: 2488185]
Wong 2001 {published data only}
  • 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: 11431192]

References to studies excluded from this review

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Characteristics of studies
  18. References to studies included in this review
  19. References to studies excluded from this review
  20. References to ongoing studies
  21. Additional references
  22. References to other published versions of this review
Albin 1986 {published data only}
  • 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: 3816928]
Al-Wali 1992 {published data only}
  • 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}
  • 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.
Bannister 1987 {published data only}
  • 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: 3794134]
Casey 2000 {published data only}
  • 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: 11117248]
Cavdar 2004 {published data only}
  • 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: 18569916]
  • 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: 15384797]
Celik 1999 {published data only}
  • 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: 10433171]
Chadwick 1999 {published data only}
  • 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: 10630696]
Chaimovitz 1994 {published data only}
Danielsson 1997 {published data only}
  • 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}
  • de Fijter CW, Verbrugh HA, Heezius HC, van Bronswijk H, van der MJ, Oe PL, et al. Are intracellularly penetrating antibiotics warranted in CAPD-related peritonitis?. Advances in Peritoneal Dialysis 1989;5:124-7. [MEDLINE: 2577393]
  • de Fijter CW, Verbrugh HA, Heezius HC, van der 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}
  • De 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: 6843764]
Dratwa 1987 {published data only}
  • Dratwa M, Glupczynski Y, Lameire N, Matthys D, Verschraegen G, van Eeckhoute M, et al. Aztreonam in CAPD peritonitis. Lancet 1987;2(8552):213-4. [MEDLINE: 2885662]
Dryden 1993 {published data only}
Durand 1994 {published data only}
  • 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: 8312425]
Ersoy 1998 {published data only}
  • 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: 9576376]
Fabbri 1982 {published data only}
  • 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}
  • 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: 7948237]
Goffin 1997 {published data only}
  • Goffin E, Pouthier D, Vandercam B, Gigi J, van Ypersele de Strihou C. Oral ciprofloxacin to treat bacterial peritonitis associated with peritoneal dialysis. Clinical Nephrology 1996;48(6):391-2. [MEDLINE: 9438101]
Greenbaum 1995 {published data only}
  • 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}
Hancock 1989 {published data only}
  • Hancock K, Hulme B. Treatment of CAPD peritonitis with oral ciprofloxacin. Nephrology Dialysis Transplantation 1989;4(8):759. [EMBASE: 1989278988]
ISRCTN39675087 {published data only}
  • ISRCTN39675087. Efficacy of endoluminal brushes reducing peritonitis in peritoneal dialysis (PD) patients. http://controlled-trials.com/ISRCTN39675087 2006.
Keller 1984 {published data only}
  • 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: 6692648]
Klaus 2002 {published data only}
  • Klaus G, van 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]
  • 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: 11045321]
Lai 1997 {published data only}
  • 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: 9068030]
Levesque 2003 {published data only}
  • 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: 14703205]
Li 2000 {published data only}
  • 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: 10809249]
McIntosh 1985 {published data only}
  • 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: 3987798]
Mylotte 1999 {published data only}
Plum 1997a {published data only}
  • 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: 9358531]
Posthuma 1997 {published data only}
  • Peers E. Icodextrin plus glucose combinations for use in CAPD. Peritoneal Dialysis International 1997;17 Suppl 2:S68-9. [MEDLINE: 9163801]
  • Posthuma N, Verbrugh HA, Donker AJ, van 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: 10809240]
  • 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: 10507814]
  • 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]
  • 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]
  • Posthuma N, ter Wee PM, Donker AJ, Oe LP, Verbrugh HA, Peers E. Improved ultrafiltration in CCPD patients using icodextrin (i) instead of glucose (g) for the long daytime dwell [abstract]. Journal of the American Society of Nephrology 1995;6(3):513. [CENTRAL: CN-00485461]
  • Posthuma N, ter Wee PM, Donker AJ, Oe PL, Peers EM, Verbrugh HA. Assessment of the effectiveness, safety, and biocompatibility of icodextrin in automated peritoneal dialysis. The Dextrin in APD in Amsterdam (DIANA) Group. Peritoneal Dialysis International 2000;20 Suppl 2:S106-13. [MEDLINE: 10911654]
  • Posthuma N, ter Wee PM, Donker AJ, Oe PL, van Dorp W, Peers EM, et al. Serum disaccharides and osmolality in CCPD patients using icodextrin or glucose as daytime dwell. Peritoneal Dialysis International 1997;17(6):602-7. [MEDLINE: 9655161]
  • Posthuma N, ter Wee PM, Donker AJ, Verbrugh HA, Oe PL, van Dorp W. Peritoneal membrane characteristics 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-00447265]
  • Posthuma N, ter Wee PM, Donker AJ, Verbrugh HA, Oe PL, van Dorp W, et al. Icodextrin (I) use in CCPD patients during peritonitis: serum disaccharide (maltose) levels and ultrafiltratioin (UF) [abstract]. Journal of the American Society of Nephrology 1997;8(Program & Abstracts):270A. [CENTRAL: CN-00447266]
  • Posthuma N, ter Wee PM, Niessen H, Donker AJ, Verbrugh HA, Schalkwijk CG. Amadori albumin and advanced glycation end-product formation in peritoneal dialysis using icodextrin. Peritoneal Dialysis International 2001;21(1):43-51. [MEDLINE: 11280495]
  • Posthuma N, ter Wee PM, Verbrugh HA, Oe PL, Peers E, Sayers J, et al. Icodextrin instead of glucose during the daytime dwell in CCPD increases ultrafiltration and 24-h dialysate creatinine clearance. Nephrology Dialysis Transplantation 1997;12(3):550-3. [MEDLINE: 9075139]
  • Posthuma N, ter Wee PM, et al. Icodextrin (I) use in CCPD patients during peritonitis: serum disacharide levels and ultrafiltration (UF) [abstract]. Nephrology Dialysis Transplantation 1997;12(9):A184. [CENTRAL: CN-00261438]
  • Posthuma N, ter Weel PM, Donker AJ, Peers EM, Oe PL, Verbrugh HA. Icodextrin use in CCPD patients during peritonitis: ultrafiltration and serum disaccharide concentrations. Nephrology Dialysis Transplantation 1998;13(9):2341-4. [MEDLINE: 9761519]
Qamar 2009 {published data only}
  • 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: 19886322]
Ranganathan 2010 {published data only}
  • 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).
Read 1985 {published data only}
  • 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: 2856968]
Restrepo 2010 {published data only}
  • 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: 20634438]
Sharma 1971 {published data only}
Sit 2007 {published data only}
  • 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: 17565930]
Stegmayr 1991 {published data only}
  • 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: 1854868]
Stein 1995 {published data only}
  • 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: 7573018]
  • 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]
Thomae 1982 {published data only}
  • 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: 7070273]
van der Muelen 1989 {published data only}
  • van der Meulen J, de 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}
  • 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).
  • 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: 22700884]
Wang 1996 {published data only}
  • 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: 9147552]
Warady 2003 {published data only}
  • 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: 14604204]
Watkins 1998 {published data only}
  • 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}
  • 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}
  • 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}
  • 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: 8738819]
Zhang 1993 {published data only}
  • 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

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Characteristics of studies
  18. References to studies included in this review
  19. References to studies excluded from this review
  20. References to ongoing studies
  21. Additional references
  22. References to other published versions of this review
ISRCTN74962920 {published data only}
  • 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}
  • NCT01785641. Single versus combined antibiotic therapy for bacterial peritonitis in CAPD patients. http://clinicaltrials.gov/ct2/results?term=NCT01785641 (accessed 4 July 2013).

Additional references

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Characteristics of studies
  18. References to studies included in this review
  19. References to studies excluded from this review
  20. References to ongoing studies
  21. Additional references
  22. References to other published versions of this review
Alves 1993
Ates 2000
  • Ates K, Koc R, Nergizoglu G, Erturk S, Keven K, Sen A, et al. The longitudinal effect of a single peritonitis episode on peritoneal membrane transport in CAPD patients. Peritoneal Dialysis International 2000;20(2):220-6. [MEDLINE: 10809247]
Badve 2012
  • Badve SV, Hawley CM, McDonald SP, Brown FG, Boudville NC, Wiggins KJ, et al. Use of aminoglycosides for peritoneal dialysis-associated peritonitis does not affect residual renal function. Nephrology Dialysis Transplantation 2012;27(1):381-7. [MEDLINE: 21633101]
Baker 2003
Bazzato 1980
  • Bazzato G, Landini S, Coli U, Lucatello S, Fracasso A, Moracchiello M. A new technique of continuous ambulatory peritoneal dialysis (CAPD): double-bag system for freedom to the patient and significant reduction of peritonitis. Clinical Nephrology 1980;13(6):251-4. [MEDLINE: 7408242]
Booranalertpaisarn 2003
  • Booranalertpaisarn V, Eiam-Ong S, Wittayalertpanya S, Kanjanabutr T, Na Ayudhya DP. Pharmacokinetics of ceftazidime in CAPD-related peritonitis. Peritoneal Dialysis International 2003;23(6):574-9. [MEDLINE: 14703199]
CARI 2005
  • Australian and New Zealand Society of Nephrology. Caring for Australians with Renal Impairment Part 4: Proteinuria, peritonitis and CMV infection guidelines. Nephrology 2005;9(Suppl 3):S91-106.
Carmeli 2002
  • Carmeli Y, Eliopoulos GM, Samore MH. Antecedent treatment with different antibiotic agents as a risk factor for vancomycin-resistant Enterococcus. Emerging Infectious Diseases 2002;8(8):802-7. [MEDLINE: 12141965]
Carozzi 1988
  • Carozzi S, Nasini MG, Kunkl A, Cantarella S, Lamperi S. Response of CAPD patients with a high incidence of peritonitis to intraperitoneal immunoglobulin therapy. ASAIO Transactions 1988;34(3):635-9. [MEDLINE: 3264176]
Choi 2004
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Coles 2000
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References to other published versions of this review

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Characteristics of studies
  18. References to studies included in this review
  19. References to studies excluded from this review
  20. References to ongoing studies
  21. Additional references
  22. References to other published versions of this review
Wiggins 2005
  • Wiggins KJ, Craig JC, Johnson D, Strippoli GF. Treatment for peritoneal dialysis-associated peritonitis. (Protocol). Cochrane Database of Systematic Reviews 2005, Issue 2. [DOI: 10.1002/14651858.CD005284]
Wiggins 2008