{"id":6604,"date":"2025-03-14T17:26:43","date_gmt":"2025-03-14T17:26:43","guid":{"rendered":"https:\/\/edren.org\/ren\/?page_id=6604"},"modified":"2025-03-14T17:26:43","modified_gmt":"2025-03-14T17:26:43","slug":"peritonitis-treatment-day-by-day","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/handbook\/pd-handbook\/protocol-for-the-management-of-pd-peritonitis\/peritonitis-treatment-day-by-day\/","title":{"rendered":"Peritonitis Treatment Day by Day"},"content":{"rendered":"<p><strong>Peritonitis Management Day by Day<\/strong><\/p>\n<p>&nbsp;<\/p>\n<p><strong><u>Day 0<\/u><\/strong><\/p>\n<p><strong>Clinical assessment \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong><\/p>\n<ul>\n<li>Take history: Obvious contamination of catheter or previous PD infections?<\/li>\n<li>Temperature, BP, heart rate + examine abdomen ?\u00a0 exit site\/tunnel infection.<\/li>\n<\/ul>\n<p><strong>Essential samples:<\/strong><\/p>\n<ul>\n<li>Send 1x universal container to microbiology for urgent WCC + gram stain<\/li>\n<li>Send PD fluid in blood culture bottles (10mls per bottle) labelled \u201cPD Fluid\u201d<\/li>\n<li>If exit site exudate present, swab and send for culture<\/li>\n<\/ul>\n<p><strong>Diagnosis:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong><\/p>\n<ul>\n<li><strong>If cloudy bag and\/or patient unwell do not delay antibiotic until WCC back<\/strong><\/li>\n<li><strong>PD fluid WCC &gt;100\/mm3 + 50% PMNs\u00a0 confirms peritonitis<\/strong><\/li>\n<\/ul>\n<p><strong>Dose Antibiotic:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong><\/p>\n<ul>\n<li><strong>Ceftazidime 1.5g IP in 6 hour dwell daily<\/strong><strong>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0<\/strong><\/li>\n<li><strong> Vancomycin 30mg\/kg in 6 hour dwell<\/strong><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong><u>Day 1<\/u><\/strong><\/p>\n<p><strong>Monitoring<\/strong>:<\/p>\n<ul>\n<li>If inpatient, consider sending further WCC daily and checking vancomycin level daily<strong>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/strong><\/li>\n<li><strong>(<\/strong>If outpatient, no routine samples needed)<\/li>\n<\/ul>\n<p><strong>Dose antibiotic:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong><\/p>\n<ul>\n<li><strong>Ceftazidime 1.5g IP in 6 hour dwell daily<\/strong><\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong><u>Day 2<\/u><\/strong><\/p>\n<p><strong>Monitoring<\/strong>:<\/p>\n<ul>\n<li>Send further PD fluid samples for WCC and culture as per day 0<\/li>\n<li>Check vancomycin level day 2. If level &gt;20, repeat \u00a0in 24 hours.<\/li>\n<\/ul>\n<p><strong>Dose Antibiotic:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong><\/p>\n<ul>\n<li><strong>Ceftazidime 1.5g IP in 6 hour dwell daily<\/strong><\/li>\n<li><strong>Vancomycin 30 mg\/kg if vancomycin trough &lt;20mg\/l<\/strong><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong><u>Day 3<\/u><\/strong><\/p>\n<p><strong>Monitoring<\/strong>:<\/p>\n<ul>\n<li>Check vancomycin level if day 2 level was &gt;20.<\/li>\n<\/ul>\n<p><strong>Review culture:<\/strong><\/p>\n<ul>\n<li>If organism identified, follow relevant organism-specific protocol.<\/li>\n<li>\u00a0 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.<\/li>\n<\/ul>\n<p><strong>Dose Antibiotic:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong><\/p>\n<ul>\n<li><strong>Ceftazidime 1.5g IP in 6 hour dwell daily<\/strong><\/li>\n<li><strong>Vancomycin 30mg\/kg if vancomycin trough &lt;20mg\/l<\/strong><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong><u>Day 4<\/u><\/strong><\/p>\n<p><strong>Monitoring<\/strong>:<\/p>\n<ul>\n<li>Check further vancomycin trough if level day 2 was &lt;20 or if patient has not yet needed a second dose of vancomycin.<\/li>\n<li>Timing of subsequent vancomycin level checks will depend upon how quickly the initial level fell &lt;20 and a second dose was given \u2013 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 <em>first<\/em> dose) then check next vancomcyin level day 4 (48 hours after <em>second<\/em> dose).<\/li>\n<\/ul>\n<p><strong>Review culture:<\/strong><\/p>\n<ul>\n<li>If organism identified, follow relevant organism-specific protocol.<\/li>\n<li>If no culture result or remains culture negative, continue both antibiotics.<\/li>\n<\/ul>\n<p><strong>Dose Antibiotic:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong><\/p>\n<ul>\n<li><strong>Ceftazidime 1.5g IP in 6 hour dwell daily<\/strong><\/li>\n<li><strong>Vancomycin 15mg\/kg if vancomycin trough &lt;20mg\/l<\/strong><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong><u>Day 5<\/u><\/strong><\/p>\n<p><strong>Monitoring<\/strong>:<\/p>\n<ul>\n<li>Send further PD fluid samples for WCC and culture as per day 0<\/li>\n<\/ul>\n<p><strong>Review culture:<\/strong><\/p>\n<ul>\n<li><strong>If WCC not falling despite appropriate antibiotic, PD catheter should be removed. <\/strong><\/li>\n<li>If organism identified, follow relevant organism-specific protocol.<\/li>\n<li>If remains culture negative, continue both antibiotics until day 14.<\/li>\n<\/ul>\n<p><strong>Dose Antibiotic:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/strong><\/p>\n<ul>\n<li><strong> Ceftazidime 1.5g IP in 6 hour dwell daily<\/strong><\/li>\n<li><strong>Vancomycin 15mg\/kg if vancomycin trough &lt;20mg\/l<\/strong><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong><u>Day 6 onward<\/u><\/strong><\/p>\n<ul>\n<li>Note that if PD catheter is removed antibiotics should continue for 2 weeks (iv or oral according to clinical condition and organism cultured).<\/li>\n<li><strong>Antibiotic choice and duration of treatment depend upon organism cultured \u2013 please refer to the relevant section in the PD protocol &#8220;long version&#8221; on EDREN.<\/strong><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Peritonitis Management Day by Day &nbsp; Day 0 Clinical assessment \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Take history: Obvious contamination of catheter or previous PD infections? Temperature, BP, heart rate + examine abdomen ?\u00a0 exit site\/tunnel infection. Essential samples: Send 1x universal container to microbiology for urgent WCC + gram stain Send PD fluid in\u2026<\/p>\n<p> <a class=\"continue-reading-link\" href=\"https:\/\/edren.org\/ren\/handbook\/pd-handbook\/protocol-for-the-management-of-pd-peritonitis\/peritonitis-treatment-day-by-day\/\"><span>Continue reading<\/span><i class=\"crycon-right-dir\"><\/i><\/a> <\/p>\n","protected":false},"author":14,"featured_media":0,"parent":6586,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"no","_lmt_disable":"","footnotes":""},"class_list":["post-6604","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/6604","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/users\/14"}],"replies":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/comments?post=6604"}],"version-history":[{"count":3,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/6604\/revisions"}],"predecessor-version":[{"id":6607,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/6604\/revisions\/6607"}],"up":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/6586"}],"wp:attachment":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/media?parent=6604"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}