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Peritonitis Protocol

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

Maintenence: Every exchange for 10 -14 days Vancomycin 20 mg/ per liter IP 

Tobramycin 4mg/ per liter IP

Protocol II:
Loading Dose: Keflin 15 - 25 mg/kg IP or IV 

Tobramycin 1.75 mg/kg IP or IV

Maintenence: Every exchange for 10 -14 days Keflin 125 mg/ per liter IP 

Tobramycin 4mg/ per liter IP

Protocol III:
Loading Dose: Tobramycin 1.75 mg/kg IP or IV 

Ticarcillin 15 -25 mg/kg IP or IV

Maintenence: Every exchange for 10 -14 days Tobramycin 4mg/ per liter IP 

Ticarcillin 100 mg/ per liter IP


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)
  300 mg p.o. qD x 10 days (Children) 
infants dose adjusted per wieght

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

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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