Mwandishi:
Mhariri:
Imeboreshwa:
ULY CLINIC
ULY CLINIC
20 Oktoba 2026, 08:11:53
Peritoneal dialysis catheter-related infections and peritonitis
Exit-site infection: redness, swelling, tenderness, pus at the exit site.
Tunnel infection: pain, redness or induration along the tunnel.
Peritonitis: abdominal pain, fever, cloudy dialysate; effluent WBC above 100/µl with over 50% neutrophils; culture the effluent.
Prevention
Leave the first dressing 7 days; then clean the exit site at least twice weekly and after water exposure; consider daily mupirocin or gentamicin cream; screen for nasal S. aureus; hand hygiene and connection training.
Insertion prophylaxis: C: cefazolin 1–2 g IV (children 25 mg/kg, maximum 2 g) single dose; vancomycin if severe beta-lactam allergy or MRSA risk.
Treatment
Condition | First line | Alternative / duration |
Exit-site infection | B: Amoxicillin + clavulanic acid PO 500/125 mg twice daily (children 250/125 mg), OR B: cefalexin 250–500 mg twice daily (children 25–50 mg/kg/day) | Ciprofloxacin 500–750 mg once daily, clarithromycin 500 mg then 250 mg every 12 hours, or clindamycin 300–450 mg every 6–8 hours; 7–10 days |
MRSA exit-site infection | S: Clindamycin 300 mg every 8 hours (children 10–20 mg/kg/day) | Co-trimoxazole 960 mg every 12 hours (children 4–5 mg/kg TMP); 2–3 weeks |
Tunnel infection | As for exit-site infection | IV if severe; 2–3 weeks; remove catheter if refractory |
Peritonitis (intraperitoneal) | S: Vancomycin 15–30 mg/kg every 5–7 days (max 2 g) AND D: ceftazidime or S: cefepime 1–1.5 g per exchange (children 50 mg/kg, max 1.5 g) | A: gentamicin 0.6 mg/kg once daily (max 50 mg); 2 weeks (3 weeks for Pseudomonas or S. aureus) |
Adjust to culture; remove the catheter in fungal, refractory or relapsing peritonitis.
Imeandikwa:
20 Oktoba 2026, 08:09:44
Rejea za mada hii:
Ministry of Health, United Republic of Tanzania. Standard Treatment Guidelines and National Essential Medicines List for Tanzania Mainland (STG & NEMLIT). 7th ed. Dodoma: Ministry of Health; 2026. Chapter 21, Kidney and Urological Disorders: section 21.2 Peritoneal Dialysis Catheter-Related Infections (Tables 21.11–21.14), pp. 538–539.