Vancomycin therapy for gram-positive peritonitis in patients on CAPD.

We describe the use of vancomycin in the therapy of gram-positive peritonitis in patients on CAPD. Two ways of administration were in comparison: a) the intraperitoneal (IP) route, with the intraperitoneal administration of 30 mg/l vancomycin for 10 days and b) the intravenous (IV) route with 2 infusions of 1 gram of vancomycin, the first one on the day of the diagnosis of gram-positive peritonitis and the second 7 days later. Each one of these therapeutic schedules was applied at random for 20 episodes of peritonitis out of 40 episodes with gram-positive organisms (28 Staph. albus, 10 Staph aureus and 2 Streptococcus). Remission of clinical symptoms occurred in 49-72 hours in both groups, while macroscopic clearing of dialysate effluent and sterilization of cultures were observed in 4-7 days. Recurrence of peritonitis was seen in 4 patients of the IV group 2 weeks after the administration of the second dose of vancomycin. We conclude that the use of vancomycin with either of the two ways of administration is of great value in the treatment of gram-positive peritonitis. The IV infusion was less successful but it seems to be useful for the out-patient treatment of gram-positive peritonitis.