Ciprofloxacin peritonitis

Patients who have previously experienced spontaneous bacterial peritonitis and have low-protein ascites (ascitic fluid albumin less than 1 g/dL [less than 10 g/L]) are candidates for long-term prophylactic therapy. Recommended regimens include either a single trimethoprim-sulfamethoxazole doublestrength tablet 5 days per week (Monday through Friday) or ciprofloxacin 750 mg once weekly.19,46 Any patient who has experienced an episode of variceal bleeding should also receive prophylactic antibiotics. 

Intranasal S. aureus increases the risk of S. aureus exit-site infections, tunnel infections, peritonitis, and subsequent catheter loss.49 Several measures have been used to decrease the risk of peritonitis caused by S. aureus, including mupirocin cream applied daily around the exit site, intranasal mupirocin cream twice daily for 5 days each month, or rifampin 300 mg orally twice daily for 5 days, repeated every 3 months.49 Mupirocin use is preferred over rifampin to prevent the development of resistance to rifampin, although mupirocin resistance has also been reported.49 Other measures that have been used to decrease both S. aureus and P. aeruginosa infections include gentamicin cream applied twice daily and ciprofloxacin otic solution applied daily to the exit site.49... 

Antimicrobials. Aminoglycosides (neomycin, streptomycin, gentamicin), polypeptides (colistimethate sodium, polymyxin B) and perhaps the quinolones (e.g. ciprofloxacin) may cause postoperative breathing difficulty if they are instilled into the peritoneal or pleural cavities. It appears that the antibiotics both interfere with the release of acetylcholine and also have a competitive curarelike effect on the acetylcholine receptor. 

The penetration of routinely used fluoroquinolones into ascitic fluid after intravenous administration has been studied in patients with uncompensated hepatic cirrhosis (125). Three patients received three doses of ciprofloxacin 200 mg, six received three doses of ciprofloxacin 300 mg, seven received three doses of pefloxacin 400 mg, and six received three doses of ofloxacin 400 mg. Pefloxacin and ofloxacin produced serum and ascitic fluid concentrations above the MICs of the common pathogens that cause spontaneous bacterial peritonitis, and the authors concluded that... 

An 84-year-old man with diabetic nephropathy and end-stage renal disease began continuous ambulatory peritoneal dialysis and over the next year had four episodes of exit-site infection and peritonitis and used mupirocin ointment. The exit-site catheter became dilated and during an episode of infection for which he used mupirocin on 6 successive days, a longitudinal rupture developed in the peritoneal catheter, which was removed. The peritoneal liquid contained Escherichia coli and Proteus mirabilis and the catheter tip contained E. coli and Enterobacter cloacae. He was treated with ciprofloxacin, without complications, and after 1 month a new peritoneal catheter was inserted. 

Kane, M.P. Bailie, G.R. Moon, D.G. Siu, I. Stability of ciprofloxacin injection in peritoneal dialysis solutions. Am.J.Hosp.Pharm., 1994, 51, 373-377 [stability-indicating]... 

Golper TA, Hartstein AI, Morthland VH, Christensen JM. Effects of antacids and dialysate dwell times on multiple-dose pharmacokinetics of oral ciprofloxacin in patients on continuous ambulatory peritoneal dialysis. Antimicrob Agents Chemother (19S7) 31, 1787-90. 

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