CAPD Peritonitis and Fluoroquinolones: A Review

Abstract

Fluoroquinolones are potentially useful agents in the treatment of CAPD peritonitis, due to their wide spectrum of antimicrobial activity, favourable pharmacokinetics, oral availability and their relatively low toxicity. The microbiological, pharmacokinetic, and clinical aspects of these drugs in CAPD are reviewed. Ciprofloxacin showed superior in-vitro activity in comparison with various beta lactam agents; gentamicin and vancomycin against staphylococci and particularly against Gram-negative bacteria. Its activity against streptococci is low. The in vitro activity of fiuoroquinolones is reduced in peritoneal dialysis fluid. A limited rise in serum levels is observed with daily administration of fiuoroquinolones in CAPD patients during 5–15 days. Effective dialysate levels are reached in most patients after oral dosing, but these levels are highly variable and low levels are often observed during the first day, an d with short dwell times. Concurrent administration with phosphate binding antacids should be avoided. Initial clinical experience shows that ciprofloxacin and ofloxacin may be effective agents to treat CAPD peritonitis via the oral route. They are usually well tolerated, although convulsions have been observed. The relative efficacy in comparison with “standard therapies” will have to be shown in comparative studies.