Suggestions for Clinical Care

Where local or international guidelines are available they should be used to guide therapy. Peritoneal dialysate effluent should be collected and processed in an appropriate manner to ensure culture-negative episodes account for < 20% of all PD-associated peritonitis. While there is no good evidence to support specific antibiotic choice, empiric intraperitoneal therapy should consider local microbiological resistance profiles and cover Gram-positive and Gram-negative bacteria. Gram-positive organisms may be covered by vancomycin or a cephalosporin and Gram-negative organisms by a third generation cephalosporin or aminoglycoside. When there is a suitable alternative, aminoglycoside use should be limited to avoid their adverse effects of nephrotoxicity and ototoxicity. Dual antibiotic therapy is indicated for Pseudomonas spp. peritonitis.