A Randomized controlled trial comparing Topical use of Mupirocin versus Medihoney for the prevention of Infection at Tenckhoff Exit Site in Peritoneal Dialysis Patients

The most important complications of long-term peritoneal dialysis (PD) are peritonitis and exit site infections (ESI) as both can result in catheter loss and technique failure . ESI are associated with six-fold risk of peritonitis, catheter loss and considerable morbidity.  Simultaneous ESI and peritonitis results in catheter removal in half the cases. Interest has been focussed on decolonisation of patients with these organisms.  Many studies using mupirocin, gentamicin, neomyci, and rifampicin in varying combinations of oral, topical or intranasal application have been done to examine use of antimicrobials to combat ESI’s and reduce peritonitis and catheter removal.

There are no strong recommendations in the international guidelines. There is need of alternative chemoprophylaxis as mupirocin is active against gram-positive organisms and gentamicin is mainly active against gram-negative organisms. Honey is an antimicrobial agent against a broad spectrum of organisms such as methicillin-resistant S. aureus, multidrug-resistant gram-negative organisms, and vancomycin-resistant enterococci and fungi.  Honey (Medihoney, Comvita, New Zealand), is active against all organisms and with no reported resistance so far, is used at the exit site of central venous (CV) catheters. With the success of using Medihoney at the exit site of CV catheters, we propose therefore to conduct a study comparing topical medihoney at the exit site with topical mupirocin irrespective of the S.aureus carrier status of the patient.