A randomised prospective comparison of oral ofloxacin and intraperitoneal vancomycin plus aztreonam in the treatment of bacterial peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD).
Forty six patients who developed 48 episodes of peritonitis while on CAPD were randomised to receive either oral ofloxacin or intraperitoneal (i.p.) vancomycin/aztreonam. Three patients were excluded from analysis: 2 were transferred to other hospitals and 1 was later found to have candida peritonitis. Of the remainder, 22 episodes were treated with oral ofloxacin and 23 with i.p. vancomycin/aztreonam. The primary cure rate in the oral ofloxacin and i.p. vancomycin/aztreonam group was 77.3% and 87.5% respectively. There were 3 primary failures and 2 relapses in the former and 1 failure and 2 relapses in the latter group. Two of the 4 primary failures were peritonitis episodes secondary to infection with pseudomonas species. The total number of days of hospital stay was 48 and 58 respectively in the two groups. Analysis of the cost of treatment revealed that i.p. vancomycin/aztreonam was 30 times more expensive than oral ofloxacin. Despite a slightly higher cure rate with i.p. vancomycin/aztreonam, oral ofloxacin is a more cost-effective primary treatment of bacterial peritonitis in patients on CAPD especially in countries with a limited health budget.