Continuous ambulatory peritoneal dialysis (CAPD), a widely used replacement therapy for end stage renal failure, is frequently complicated by bacterial peritonitis. The infecting organisms are mainly staphylococci and gram negative aerobes. Pefloxacin is a fluorinated quinolone with good in-vitro activity against these pathogens. The objective of this open non comparative study is to determine the effectiveness and safety of oral pefloxacin mesylate as a single first line antimicrobial treatment of CAPD peritonitis. 28 episodes of CAPD peritonitis were treated with a stat dose of pefloxacin 800 mg. followed by 400 mg. 12 hourly for about 15-18 days. A pefloxacin sensitive organism was isolated in 17 episodes. 11 episodes were culture negative. Treatment results showed a cure in seventeen (60.7%), no treatment response in seven (25%), and relapses in four (14.2%). Side effects encountered were not serious except for one incident of a generalized seizure. We conclude that oral pefloxacin is convenient, safe and effective enough as a single first line antimicrobial treatment for CAPD peritonitis.
In a prospective study on 47 patients, 16 mg of gentamicin per two litres dialysate was administered intraperitoneally at every cycle of intermittent peritoneal dialysis, carried out over the course of several days. Serum gentamicin sampling, pure tone audiometry and caloric tests were performed before and during the treatment. The gentamicin levels reached at the end of the thirtieth cycle were observed to be low. In view of this, the risk of acute ototoxicity was considered to be minimal. This was confirmed by the absence of clinical audiometric or vestibulometric evidence of toxicity.
One hundred children with peritonitis resulting from a perforated appendix were treated with ceftazidime or netilmicin. Metronidazole was added to both groups to treat the anaerobic organisms commonly associated with the infecting aerobic organisms in peritonitis. Escherichia coli was the most common aerobe found in peritoneal pus. Wound infection occurred in nine patients of the netilmicin group and in none treated with ceftazidime (P less than 0.01). No bacterial resistance was evident in the ceftazidime group, but gram-positive streptococci found in eight patients were resistant to netilmicin. Thus it is recommended that an antibiotic of the penicillin group be added if netilmicin is used to treat peritonitis. The results indicate that ceftazidime was more effective than netilmicin in the treatment of children with peritonitis resulting from a perforated appendix.
Leiomyoma of the caecum is a rare tumour. While leiomyomata are known to arise from any part of the large bowel, caecum is a rare site. The largest series to date is that of Mackenzie" who reviewed 37 cases of myomatous tumours of the colon, two of which were complicated by perforation. More recently, Swerdlow" reported another case of a perforated caecal leiomyoma. We now report a patient who was operated at the stage of abscess formation without perforation.
226 peritoneal dialyses were performed on 100 patients. 28 patients presented with acute renal failure. Uraemia was the most frequent indication for dialysis. Peritonitis was an important complication and Acinetobacter species accounted for 51.5% of the positive cultures. Other complications included poor dialysate drainage and hypokalemia. Mortality was mainly due to causes unrelated to peritoneal dialysis.
38 episodes of peritonitis in 28 patients were recorded among 97 patients undergoing a total of 159 peritoneal dialysis at the Nephrology Unit, General Hospital, Kuala Lumpur between November 1979 to June 1980. Of these only 14 episodes were associated with a positive bacterial culture. Organism of the Moraxella-Acinetobacter group were responsible in 8 episodes. There were 16 positive cultures in patients who had no clinical evidence of peritonitis. The interpretation of bacterial peritonitis in patients undergoing peritoneal dialysis must be made on the basis of clinical findings and bacteriological reports.
Five cases of generalized peritonitis secondary to perforating lesions of the gastro-intestinal tract were benefited by treatment with aureomycin. Four of these received the drug postoperatively: the fifth recovered withoLut surgical intervention.