Q: I am 63 years old. I am on CAPD dialysis since the past 6 months. I suffered from two episode of peritonitis. Both the times the culture and sensitivity test did not show any growth. My nephrologist prescribed Vancomycin 1 gm, Gentamicin 80 mg and Heparin 1ml in a single bag. He also prescribed Ciplox oral tablets 500 mg BD for seven days. Drained fluid were clear after 6 hours. What is the standard procedure for treatment of peritonitis?

A:The treatment of peritonitis in a Continuous Ambulatory Peritoneal Dialysis (CAPD) patient is based upon its initial clinical suspicion relying upon the symptoms and signs while awaiting the confirmed diagnosis from a laboratory investigation of the peritoneal fluid. Based upon the more common symptoms and signs of peritonitis – i.e. abdominal pain, cloudy peritoneal fluid, fever, nausea, diarrhoea and abdominal tenderness - the peritoneal fluid is examined for a set of tests that include cell count, Gram’s stain and culture. All tests are intended to demonstrate the presence and type of pathogenic organism. While the lab reports are awaited, the patient is initiated on an empirical treatment with a combination of antibiotics. The choice of antibiotic depends upon its different coverage and spectrum of action against the underlying suspected pathogenic organisms of common occurrence. Once the initial peritoneal culture and sensitivity report is back (usually within 72 hours), the antibiotics are adjusted to culture and sensitivity. The duration of treatment with the adjusted antibiotic therapy can vary anywhere from 14-21 days depending upon the culture report. In many cases, if in spite of adjusting the antibiotics, there is no improvement in the symptoms and the signs, then one has to pursue with a repeat culture and evaluate the peritoneal dialysis catheter exit site and any intra-abdominal source of infection. In extreme cases, it does become an indication for catheter removal and transfer to haemodialysis at least transiently.