In a prospective randomized clinical trial 84
peritonitis episodes were treated with
cephradine, either orally or intraperitoneally. No difference in treatment outcome between both groups could be demonstrated. In episodes caused by susceptible micro-organisms a good response was seen in 82% in the oral and 82% in the intraperitoneal groups. These clinical findings were supported by the demonstration of adequate
cephradine concentrations in serum and
dialysate after oral as well as after intraperitoneal administration. Altogether
cephradine was given orally or intraperitoneally in 88 episodes of
peritonitis as
drug of first choice. In 52 a complete cure was obtained, in 36 another
antibiotic was subsequently needed as soon as bacterial susceptibility was known. No patient deteriorated appreciably during the delay between the start of
cephradine and the switch to another
antibiotic. Of the 36 episodes 14, caused by methicillin-resistant Staphylococcus epidermidis, responded well initially to
cephradine but relapsed later. Change to another
antibiotic effected a complete recovery in all 14 cases. Of the remaining 22 episodes, 14 were cured by the other
antibiotic, in eight the
catheter had to be removed.
Aminoglycosides could be avoided except for ten of the episodes. During
peritonitis CAPD was continued, in 71% of the cases on an outpatient basis. Mortality due to
peritonitis was absent. We conclude that oral
cephradine can be used as
drug of first choice in the initial treatment of
CAPD peritonitis, because a good initial response was obtained in 66 (52 + 14) i.e. 75% of 88 episodes. However, complete cure by
cephradine alone was achieved in only 60%.(ABSTRACT TRUNCATED AT 250 WORDS)