defining the optimal duration of treatment for "low-risk" peritoneal dialysis-related peritonitis

Conditions: Peritoneal Dialysis-associated Peritonitis

Summary: background according to the international society for peritoneal dialysis (ispd) recommendations, "low-risk" peritoneal dialysis (pd)- related peritonitis caused by coagulase-negative staphylococcal species, streptococcal species, or negative bacterial culture should receive antibiotics for 2 weeks. however, relapsing, recurrent, or repeated episodes are common. objectives to compare the incidence of relapsing, recurrent, and repeat peritonitis with a 3-week course, as compared to the conventional 2-week course, antibiotic for pd-related peritonitis. hypothesis treatment of low-risk pd-related peritonitis for 3 weeks reduces the incidence of relapsing, recurrent, and repeat peritonitis. design and subjects randomized control trial of 310 episodes of "low-risk" pd-related peritonitis. study instruments and interventions patients will be randomized to receive treatment of the effective antibiotic according to the ispd recommendations for 2 weeks (conventional group) or 3 weeks (extended group). all patients will be followed for 6 months after completion of treatment. main outcome measures complete cure of the peritonitis episode, defined as survival for 6 months without relapsing, recurrent, or repeat peritonitis episodes. data analysis data will be analyzed by both intention-to-treat and per protocol approach. the incidences of complete cure, relapsing, recurrent, and repeated peritonitis episodes will be compared. expected results based on our pilot study, we expect to find a significantly lower rate of relapsing, recurrent, and repeated peritonitis episodes in the extended group. by proving that "low-risk" peritonitis episodes require 3-week course of antibiotic therapy, our result will change the current recommendation and make treatment for 3 weeks course the standard of care.

background according to the international society for peritoneal dialysis (ispd) recommendations, "low-risk" peritoneal dialysis (pd)- related peritonitis caused by coagulase-negative staphylococcal species, streptococcal species, or negative bacterial culture should receive antibiotics for 2 weeks. however, relapsing, recurrent, or repeated episodes are common. objectives to compare the incidence of relapsing, recurrent, and repeat peritonitis with a 3-week course, as compared to the conventional 2-week course, antibiotic for pd-related peritonitis. hypothesis treatment of low-risk pd-related peritonitis for 3 weeks reduces the incidence of relapsing, recurrent, and repeat peritonitis. design and subjects randomized control trial of 310 episodes of "low-risk" pd-related peritonitis. study instruments and interventions patients will be randomized to receive treatment of the effective antibiotic according to the ispd recommendations for 2 weeks (conventional group) or 3 weeks (extended group). all patients will be followed for 6 months after completion of treatment. main outcome measures complete cure of the peritonitis episode, defined as survival for 6 months without relapsing, recurrent, or repeat peritonitis episodes. data analysis data will be analyzed by both intention-to-treat and per protocol approach. the incidences of complete cure, relapsing, recurrent, and repeated peritonitis episodes will be compared. expected results based on our pilot study, we expect to find a significantly lower rate of relapsing, recurrent, and repeated peritonitis episodes in the extended group. by proving that "low-risk" peritonitis episodes require 3-week course of antibiotic therapy, our result will change the current recommendation and make treatment for 3 weeks course the standard of care.

Eligibility criteria:
inclusion criteria: * peritonitis episodes caused by cnss, streptococcal species, or negative bacterial culture exclusion criteria: * relapsing peritonitis episodes * episodes that do not show a clinical response after 5 days of antibiotic therapy * patients who have difficulty in adhering to the antibiotic therapy

Keywords: end stage renal disease infection antibiotic