Questions About PD
Any antibiotic use, irrespective of indication can alter the GI flora and lead to fungal overgrowth. Thus the recommendation is to provide anti-fungals whenever antibiotics are used. There are two randomized trials supporting this practice. Lo et al. (AJKD 1996) studied the use of nystatin 500,000 units four times per day vs. placebo during use of antibiotics whatever the indication. Restrepo et al. (PDI 2010) studied fluconazole 200 mg every 48 hours vs. placebo when patients were receiving antibiotics for peritonitis. In both trials the incidence of fungal peritonitis was reduced with the anti-fungal prophylaxis. The 2016 ISPD peritonitis recommendations (Li et al. PDI 2016) recommends antifungal prophylaxis at the time of antibiotic use, but does not specific agent.