Peritonitis Treatment Day by Day

Peritonitis Management Day by Day

 

Day 0

Clinical assessment       

  • Take history: Obvious contamination of catheter or previous PD infections?
  • Temperature, BP, heart rate + examine abdomen ?  exit site/tunnel infection.

Essential samples:

  • Send 1x universal container to microbiology for urgent WCC + gram stain
  • Send PD fluid in blood culture bottles (10mls per bottle) labelled “PD Fluid”
  • If exit site exudate present, swab and send for culture

Diagnosis:                          

  • If cloudy bag and/or patient unwell do not delay antibiotic until WCC back
  • PD fluid WCC >100/mm3 + 50% PMNs  confirms peritonitis

Dose Antibiotic:              

  • Ceftazidime 1.5g IP in 6 hour dwell daily                                            
  • Vancomycin 30mg/kg in 6 hour dwell

 

Day 1

Monitoring:

  • If inpatient, consider sending further WCC daily and checking vancomycin level daily                                         
  • (If outpatient, no routine samples needed)

Dose antibiotic:        

  • Ceftazidime 1.5g IP in 6 hour dwell daily

 

Day 2

Monitoring:

  • Send further PD fluid samples for WCC and culture as per day 0
  • Check vancomycin level day 2. If level >20, repeat  in 24 hours.

Dose Antibiotic:              

  • Ceftazidime 1.5g IP in 6 hour dwell daily
  • Vancomycin 30 mg/kg if vancomycin trough <20mg/l

 

Day 3

Monitoring:

  • Check vancomycin level if day 2 level was >20.

Review culture:

  • If organism identified, follow relevant organism-specific protocol.
  •   If no culture result or remains culture negative, continue both antibiotics and send further PD fluid sample for cell count, culture and discuss with microbiology: consider additional culture methods including fungal or mycobacterial culture.

Dose Antibiotic:              

  • Ceftazidime 1.5g IP in 6 hour dwell daily
  • Vancomycin 30mg/kg if vancomycin trough <20mg/l

 

Day 4

Monitoring:

  • Check further vancomycin trough if level day 2 was <20 or if patient has not yet needed a second dose of vancomycin.
  • Timing of subsequent vancomycin level checks will depend upon how quickly the initial level fell <20 and a second dose was given – as a guide, aim to check the subsequent vancomycin level s after the same number of days eg if the second dose required on day 2 (48 hours after first dose) then check next vancomcyin level day 4 (48 hours after second dose).

Review culture:

  • If organism identified, follow relevant organism-specific protocol.
  • If no culture result or remains culture negative, continue both antibiotics.

Dose Antibiotic:              

  • Ceftazidime 1.5g IP in 6 hour dwell daily
  • Vancomycin 15mg/kg if vancomycin trough <20mg/l

 

Day 5

Monitoring:

  • Send further PD fluid samples for WCC and culture as per day 0

Review culture:

  • If WCC not falling despite appropriate antibiotic, PD catheter should be removed.
  • If organism identified, follow relevant organism-specific protocol.
  • If remains culture negative, continue both antibiotics until day 14.

Dose Antibiotic:              

  • Ceftazidime 1.5g IP in 6 hour dwell daily
  • Vancomycin 15mg/kg if vancomycin trough <20mg/l

 

Day 6 onward

  • Note that if PD catheter is removed antibiotics should continue for 2 weeks (iv or oral according to clinical condition and organism cultured).
  • Antibiotic choice and duration of treatment depend upon organism cultured – please refer to the relevant section in the PD protocol “long version” on EDREN.