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Purpose: To Adequately Treat Peritonitis
Differential Diagnosis
1. Dialysate WBC count > 100/mm3
2. Dialysate WBC differential > 50 %
3. Positive Dialysate culture
Dialysate Sample - Initial
1. Cell count with differential
2. Cultures with sensitivity: Routine,
AFB, fungus, anaerobic
Treatment Protocols
1. For symptomatic relief, 2-3 rapid flushes
2. Antibiotic Therapy
| Protocol I: |
| Loading Dose: |
Vancomycin 7.5 mg/kg. IP or IV
Tobramycin 1.75 mg/kg IP or IV
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| Maintenence: Every exchange for 10 -14 days |
Vancomycin 20 mg/ per liter IP
Tobramycin 4mg/ per liter IP
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| Protocol II: |
| Loading Dose: |
Keflin 15 - 25 mg/kg IP or IV
Tobramycin 1.75 mg/kg IP or IV
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| Maintenence: Every exchange for 10 -14 days |
Keflin 125 mg/ per liter IP
Tobramycin 4mg/ per liter IP
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| Protocol III: |
| Loading Dose: |
Tobramycin 1.75 mg/kg IP or IV
Ticarcillin 15 -25 mg/kg IP or IV
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| Maintenence: Every exchange for 10 -14 days |
Tobramycin 4mg/ per liter IP
Ticarcillin 100 mg/ per liter IP
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Please note: Appropriate changes are made according to clinical status and organism sensitivity
Special Treatment Approaches
1. Rifampin: used along with IP Vancomycin to treat Staph Aureus peritonitis
| Dosage: |
600 mg p.o. qD x 10 days (Adult) |
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300 mg p.o. qD x 10 days (Children)
infants dose adjusted per wieght |
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2. Piperacillin or Ticarcillin: used to treat Gram negatives organisms (ie. Pseudomonas)
| Loading Dose: |
15 - 25 mg/kg IP or IV |
| Manitenence: Every exchange for 10 -14 days |
100 mg/ per liter IP |
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Laboratory Follow up
1. Day four of therapy:
Repeat cell counts and differential
Repeat routine culture and sensitivity
notes:
Confirm sensitivies
Ideal specimen is overnight dwell
More laboratory tests may be ordered PRN patient's status
2. Four days after completion of therapy
Final cell count and differential
Final routine cultures
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