Intraperitoneal cefepime a feasible first-line treatment in CAPD-associated peritonitis

Use of intraperitoneal (IP) cefepime monotherapy proves noninferior to conventional combination therapy in the management of continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis, inducing resolution at day 10, according to the results of an open-label trial.

The study randomized 144 adult peritoneal dialysis (PD) patients with CAPD-associated peritonitis to receive either IP monotherapy of cefepime (1g/d; n=70) or IP combination of cefazolin plus ceftazidime (1g/d; n=74) both given as continuous dosing. Baseline demographic and clinical characteristics were similar between the treatment groups.

Resolution of peritonitis at day 10, the primary endpoint, occurred with greater frequency in the monotherapy than in the combination group (82.6 percent vs 81.1 percent; treatment difference, 1.5 percent, 90 percent confidence interval [CI], –9.1 to 12.1; p=0.04).

There was no significant between-group difference in terms of initial response rate (65.7 percent vs 60.8 percent; treatment difference, 4.9 percent, 95 percent CI, –10.8 to 20.6; p=0.5) and complete cure rate (80.0 percent vs 80.6 percent; treatment difference, –0.6 percent, 95 percent CI, –13.9 to 12.8; p=0.7).

In the monotherapy group, peritonitis relapsed in 4.6 percent of patients and recurred in another 4.6 percent as opposed to 4.2 percent and 5.6 percent of patients in the combination-therapy group, respectively (p=0.9 and p=0.8).

All-cause mortality was slightly higher in the monotherapy group (7.1 percent vs 2.7 percent; treatment difference, 4.4 percent, 95 percent CI, –2.6 to 11.5), although the difference was not statistically significant (p=0.2).

The present data suggest that IP cefepime monotherapy may be a reasonable first-line treatment alternative for patients with CAPD-related peritonitis, researchers said.