Vancomycm and netilmicin as first line treatment of peritonitis in CAPD patients

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Abstract
The first line treatment of peritonitis in patients on continuous ambulatory pentoneal dialysis (CAPD) in our hospital was recently altered from a combination of gentamicin and cindamycin, given as continuous peritoneal lavage, to one of vancomycin and netilrnicin given in peritoneal dialysis fluid with prolonged dwell time (4–6 h). The change was prompted by the emergence of multiply resistant Staphylococcus epidermidis among CAPD patients and nursing staff. In 9 of 19 episodes of pentonitis treated with gentamicin/cindamycin, the infecting organism could still be isolated from pentoneal fluid 5–15 days after commencement of therapy. All of 35 culture verified episodes treated with vancomycin/netilmicin were cleared bacteriologically within 3 days (P <0·0005). The vancomycin and netilmicin serum levels achieved were 6·5–37·0 mg/l and 1·0–8—1 mg/l, respectively. Apart from an asthmatic reaction, possibly triggered by vancomycin, no side effects were seen. However, audiometry was not performed regularly and the possible effect of netilmicin on the residual renal function was not systematically investigated.