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bacterial peritonitis associated with peritoneal dialysis

Etiology: - peritonitis associated with CAPD usually occurs secondary to unsterile exchange technique Management: 1) most episodes are mild & may be treated on an outpatient basis 2) hospitalization is indicated for patients with a) sepsis b) resistant or recurrent infections c) suspicion of organ perforation or abscess formation 3) peritoneal lavage/exchange - 2 rapid exchanges - dextrose solution only - exchanges every 1-2 hours until pain stops - antimicrobials + heparin 500 U/L - 4 exchanges QID for 14 days - antimicrobials + heparin 500 U/L 4) peritoneal antimicrobials (in peritoneal lavage/exchange) - vancomycin 2 g. 1 dose/week. + - ceftazidime - loading dose of 500 mg/L - maintenence dose of 125 mg/L with each exchange or - aminoglycoside (doses for gentamicin) - 20 mg/L 1st exchange of day - 4-8 mg/L all other exchanges

Related

peritoneal dialysis; continuous abdominal/ambulatory (cycling) peritoneal dialysis (CAPD, CCPD)

General

secondary bacterial peritonitis (including tuberculous peritonitis)

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 275, 276, 312, 378
  2. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 326
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  4. JN learning Peritoneal Fluid Analysis in Peritoneal Dialysis-Associated Peritonitis. https://edhub.ama-assn.org/jn-learning/module/2798670