A Cochrane review included 42 studies involving a total of 2 433 patients. No superior antibiotic agent or combination of agents were identified (30 trials). Intermittent IP and continuous IP antibiotic dosing had similar treatment failure (RR 0.92, 95% CI 0.64 to 1.33, 5 trials, n=338) and relapse rates (RR 0.76, 95% CI 0.45 to 1.28, 5 trials, n=338). IP antibiotics were superior to IV antibiotics in reducing treatment failure (RR 3.52, 95% CI 1.26 to 9.81, 1 trial, n=75). Primary response and relapse rates did not differ between intraperitoneal (IP) glycopeptide-based regimens compared to first generation cephalosporin regimens, although glycopeptide regimens were more likely to achieve a complete cure (RR 1.66, 95% CI 1.01 to 3.58, 3 studies, 370 episodes). For relapsing or persistent peritonitis, simultaneous catheter removal/replacement was superior to urokinase at reducing treatment failure rates (RR 2.35, 95% CI 1.13 to 4.91, 1 trial, n=37).
Comment: The quality of evidence is downgraded by study quality (several limitations) and by inconsistency (heterogeneity in interventions and outcomes).