Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. May 6, 2015; 4(2): 287-294
Published online May 6, 2015. doi: 10.5527/wjn.v4.i2.287
Evidence-based medicine: An update on treatments for peritoneal dialysis-related peritonitis
Pasqual Barretti, João Vitor Pereira Doles, Douglas Gonçalves Pinotti, Regina Paolucci El Dib
Pasqual Barretti, Department of Internal Medicine, Botucatu Medical School, UNESP, 18618000 Botucatu, Sao Paulo, Brazil
João Vitor Pereira Doles, Douglas Gonçalves Pinotti, Botucatu Medical School, UNESP, 18618000 Botucatu, Sao Paulo, Brazil
Regina Paolucci El Dib, Department of Anesthesiology, Botucatu Medical School, UNESP, 18618000 Botucatu, Sao Paulo, Brazil
Author contributions: Doles JVP extracted the data from case series studies; Pinotti DG helped extract from RCT studies; El Dib RP wrote the initial draft of the paper; Barretti P extracted data from narrative reviews, reviewed the draft of the paper, and wrote the final version.
Conflict-of-interest: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Pasqual Barretti, MD, PhD, Professor, Department of Internal Medicine, Botucatu Medical School, Rubiao Jr w/n, UNESP, 18618000 Botucatu, Sao Paulo, Brazil.
Telephone: +55-14-38116005 Fax: +55-14-38116005
Received: July 24, 2014
Peer-review started: July 25, 2014
First decision: October 28, 2014
Revised: October 30, 2014
Accepted: December 29, 2014
Article in press: December 31, 2014
Published online: May 6, 2015

Peritonitis continues to be a major complication of peritoneal dialysis (PD), and adequate treatment is crucial for a favorable outcome. There is no consensus regarding the optimal therapeutic regimen, and few prospective controlled studies have been published. The objective of this manuscript is to review the results of PD peritonitis treatment reported in narrative reviews, systematic reviews, and proportional meta-analyses. Two narrative reviews, the only existing systematic review and its update published between 1991 and 2014 were included. In addition, we reported the results of a proportional meta-analysis published by our group. Results from systematic reviews of randomized control trials (RCT) and quasi-RCT were not able to identify any optimal antimicrobial treatment, but glycopeptide regimens were more likely to achieve a complete cure than a first generation cephalosporin. Compared to urokinase, simultaneous catheter removal and replacement resulted in better outcomes. Continuous and intermittent IP antibiotic use had similar outcomes. Intraperitoneal antibiotics were superior to intravenous antibiotics in reducing treatment failure. In the proportional meta-analysis of RCTs and the case series, the resolution rate (86%) of ceftazidime plus glycopeptide as initial treatment was significantly higher than first generation cephalosporin plus aminoglycosides (66%) and glycopeptides plus aminoglycosides (75%). Other comparisons of regimens used for either initial treatment or treatment of gram-positive rods or gram-negative rods did not show statistically significant differences. The superiority of a combination of a glycopeptide and a third generation cephalosporin was also reported by a narrative review study published in 1991, which reported an 88% resolution rate.

Keywords: Peritonitis, Peritoneal dialysis, Antibiotic, Treatment

Core tip: This manuscript revised the data from narrative and systematic review, as well as those from a proportional meta-analysis study, regarding comparisons between antibiotic regimens used to peritoneal dialysis-related treatment, empathizing protocols for initial treatment. There is no consensus on the best treatment and the only published systematic review and its recent update have failed to find superiority of any regimen. This type of analysis, commonly excludes several studies, some of them with a great number of cases. Therefore, this review intends to contribute in this issue analyzing the results from different types of reviews.