Peritoneal dialysis related infection

Preferred initial treatment: 

vancomycin intraperitoneally (IP) single dose

• leave in peritoneal cavity for 6 hours
• see dosing ranges in Intraperitoneal vancomycin dosing table below

AND ciprofloxacin* 500mg po single dose

Preferred follow on treatment: 

ciprofloxacin* 500mg po bd for 2-5 days (extend to 14 days if Gram-negative organism cultured from PD fluid)

Treatment depends on Microbiology results of cultured organisms. 

*Ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet.

Fluoroquinolones, including ciprofloxacin, are associated with disabling and potentially long-lasting or irreversible side effects. See Fluoroquinolone antibiotics - severe adverse effects. 

Preferred initial treatment: 

vancomycin intraperitoneally (IP) single dose

• leave in peritoneal cavity for 6 hours
• see dosing ranges in Intraperitoneal vancomycin dosing table below

AND gentamicin 0.6mg/kg single dose intraperitoneally (IP)

Preferred follow-on treatment: 

Treatment depends on Microbiology results of cultured organisms. 

• Leave in peritoneal cavity for over 6 hours. 

In case of vancomycin allergy, use teicoplanin 

• Leave in peritoneal cavity for 6 hours. 
• Use 1.5 - 2L dialysate (2L for weight over 90kg). 

Preferred: fluconazole 400mg po loading dose followed by fluconazole 200mg po od 

Duration: 21 days but can be reduced to 14 days post catheter removal if patient is stable and well.

Ref: ISPD Peritonitis Guideline Recommendations: 2022 update on prevention and treatment  

Treat for 14 days

Preferred: flucloxacillin 500mg po qds

Alternative:

For penicillin allergy (non-severe and severe): clindamycin 450mg po tds

For MRSA positive patients: co-trimoxazole 480mg po bd

• Where relapse occurs within 6 weeks of initial infection (otherwise regard as new infection)
• Treat for 14 days
• Always tailor therapy to Microbiology results
• Consult Micro ID, where needed

Preferred: flucloxacillin 500mg po qds PLUS rifampicin 300mg po bd

Alternative:

For penicillin allergy (non-severe and severe): clindamycin 450mg po tds PLUS rifampicin 300mg po bd

For MRSA positive patients: co-trimoxazole 480mg po bd PLUS rifampicin 300mg po bd

• Consider removal of catheter
• Where relapse occurs within 6 weeks of initial infection (otherwise regard as new infection)
• Treat for 14 days
• Always tailor therapy to Microbiology results
• Consult Micro ID, where needed

Preferred: ciprofloxacin* 500mg po bd

Alternative: discuss with Micro ID

*Ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet.

Fluoroquinolones, including ciprofloxacin, are associated with disabling and potentially long-lasting or irreversible side effects. See Fluoroquinolone antibiotics - severe adverse effects. 

vancomycin 500mg intraperitoneally single dose (preferred)

OR teicoplanin 400mg intraperitoneally single dose