“Let’s Talk About Peritoneal Dialysis” Post 9: Does My Patient Need Antibiotics Before a Dentist Visit?

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While there are less morbidity and mortality associated with peritonitis than sepsis and bacteremia, peritonitis is still a major cause of peritoneal dialysis technique failure  and mortality is not negligible.

Many measures have been studied and are now recommended for the prevention of peritonitis.  Here, we summarize and review the guideline recommendations for peri-procedural prophylaxis for the prevention of peritonitis.  First, note that dialysate drainage from the abdomen is recommended before all invasive procedures.

1.Dental proceduresA single dose of oral amoxicillin before extensive dental procedures is recommended.  This is in response to 2 small studies showing that dental procedures are a risk factor for peritonitis.  This has not been studied in any prospective trial

2. Abdomino-Pelvic invasive procedures (colonoscopy, hysteroscopy, cholecystectomy) – Intravenous ampicillin plus aminoglycoside +/- metronidazole are recommended by a systematic review, though this has not been studied prospectively.  The strongest evidence exists in colonoscopy where 97 colonoscopies were studied and rates of peritonitis were 0 vs 6.3 percent with or without pre-procedural antibiotics, respectively.  3 of the 5 peritonitis events were in patients in whom no biopsy or polypectomy were performed.  In this study, antibiotics were either for prophylaxis or treatment of extra-peritoneal infection, thus a wide variety of antibiotic combinations were given including cefuroxime, levofloxacin, vancomycin, amikacin, and metronidazole.

Given the paucity of existing data, it is not surprising that the Peritoneal Dialysis Outcomes and Practice Patterns Study has shown that there is significant heterogeneity in the implementation of this guidelines.

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