Extended antibiotic therapy unnecessary in peritoneal dialysis-related peritonitis

In patients with peritoneal dialysis (PD)-related peritonitis, extending the duration of antibiotic treatment does more harm than good, increasing the risk of repeat episodes rather than reducing the incidence or relapse or recurrence, as shown in a study.

The analysis included 254 PD patients (average age, 64 years; 59.45 male) with peritonitis receiving intraperitoneal (IP) antibiotic treatment. They were randomized to receive 1 additional week of treatment beyond the International Society for Peritoneal Dialysis (ISPD) guideline (extended group, n=127) or completion of antibiotics according to the guideline with no additional treatment (standard group, n=127). 

Actual duration of antibiotic therapy in the standard group was 14.5 days in 69 patients and 22.4 days in 58. For the extended group, it was 21.6 days in 66 patients and 28.0 days in 58. The mean difference in therapy duration was 6.4 days between the groups.

Within 6 months, the number of patients who had relapsing, recurrent, or repeat peritonitis episodes—the primary study endpoint—was similar in the extended and standard groups (28.3 percent vs 22.8 percent, respectively; p=0.34). The same was true for the rate of complete cure, without relapsing, recurrent, or repeat peritonitis (63.8 percent vs 69.3 percent, respectively; p=0.35).

In contrast, repeat peritonitis episodes occurred more frequently in the extended than the standard group (15.0 percent vs 5.5 percent; p=0.013).

The present data indicate that extended antibiotic therapy will defer some relapsing peritonitis episodes to repeated episodes but offers no net benefit. Thus, this strategy should not be recommended.