IV Antibiotics With Lavage for Severe PD Peritonitis

Randomized Trial on Intravenous Antibiotics With Adjunctive Lavage for Severe Peritoneal-dialysis Related Peritonitis

This is a randomized controlled trial to evaluate whether a switch to intravenous antibiotics with adjunctive lavage can improve the outcome of severe peritoneal dialysis related peritonitis.

The standard treatment of peritoneal dialysis (PD) related peritonitis is intraperitoneal (IP) antibiotics. In severe cases not responding to the IP antibiotics treatment, timely Tenckhoff catheter removal is needed. There is no known adjunctive measure that can improve the clinical outcome of the patients suffering from severe PD peritonitis.

Based on the past experience in the investigators' center, switching IP to intravenous route of antibiotics administration, together with adjunctive lavage was proposed to improve the clinical outcome of severe PD peritonitis, in particular a possible improved catheter salvage rate. This method will be evaluated in the present clinical trial.

Inclusion Criteria:

• Prevalent PD patients with age >= 18 years old suffering from PD peritonitis
• PD effluent white cell count >1090/mm2 on peritonitis day 3
• Lack of clinical response
• Informed consent available

Exclusion Criteria:

• PD peritonitis in association with exit site or tunnel infection
• Relapsing peritonitis (i.e. peritonitis caused by same organism within 4 weeks after completion of antibiotics therapy)
• Fungal peritonitis
• Mycobacterial peritonitis (both tuberculosis and non-tuberculosis species)
• Clinical suspicion of surgical peritonitis
• Penicillin- or cephalosporin allergy, that cefazolin and ceftazidime could not be used