How should peritoneal-dialysis-associated peritonitis be treated?

In this Practice Point commentary, we discuss Wiggins et al.'s systematic review of the treatment of peritonitis, a serious problem in peritoneal dialysis patients. Wiggins and co-workers reported that most antibiotic classes were similarly effective for the treatment of peritonitis. Despite the limited data available, the investigators found that the intraperitoneal route was more effective than the intravenous route in preventing treatment failure, that intermittent dosing of various antibiotics was as effective as continuous administration of these drugs, and that glycopeptide-based regimens were more likely than first-generation cephalosporins to achieve a complete cure. Here, we discuss the importance of treating peritonitis and the lack of and limitations of existing data, and emphasize the urgent need for well-designed, large randomized trials in this area.