The impact of intraperitoneal antibiotic administration in patients with peritoneal dialysis-related peritonitis: Systematic review and meta-analysis

Background: Peritonitis is a common and clinically important complication in patients receiving peritoneal dialysis (PD). Antibiotic administration is essential for PD-related peritonitis, but routes of administration have not been established enough. Here, we performed a systematic review to assess the efficacy and safety of intraperitoneal (IP) antibiotic administration compared to intravenous (IV) antibiotic administration in patients with PD-related peritonitis. Methods: Cochrane CENTRAL, MEDLINE, and Ichushi-Web were searched in June 2017. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed, and articles were screened by four independent reviewers. Results: Two randomized controlled trials (113 patients) were identified. IP antibiotic administration was more effective than IV antibiotic administration. The pooled risk difference between IP and IV was 0.13 (95% CI-0.17 to 0.43). Safety assessment indicated less frequency of side effects in patients receiving IP antibiotic administration. The pooled risk ratios of IV to IP regarding adverse drug reaction-related and administration route-related side effects were 5.13 (0.63 to 41.59) and 3.00 (0.14 to 65.90), respectively. Conclusion: The systematic review and meta-analysis suggested that IP antibiotic administration is more effective and safer in patients with PD-related peritonitis compared to IV antibiotic administration.