Peritonitis medical therapy: Difference between revisions

	Peritonitis Main Page
Patient Information
Overview
Causes
Classification Spontaneous Bacterial Peritonitis Secondary Peritonitis
Differential Diagnosis

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Revision as of 13:39, 12 August 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ;Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2]

Overview

Medical management of peritonitis includes hydration, prevention of septicemia and correction of electrolytes. Empiric coverage for Gram positive, gram negative bacteria and anaerobes should be initiated while awaiting culture results. Surgery or an exploratory laparotomy may be recommended in cases not responding to antibiotic treatment in order to perform a full exploration of the abdomen and to lavage the peritoneum.

Medical Therapy

Depending on the severity of the patient's state, the management of peritonitis may include:

General supportive measures such as vigorous intravenous rehydration and correction of electrolyte disturbances.
Antibiotics are usually administered intravenously, but they may also be infused directly into the peritoneum. The empiric choice of broad-spectrum antibiotics often consist of multiple drugs, and should be targeted against the most likely agents, depending on the cause of peritonitis; once one or more agents are actually isolated, therapy will of course be targeted on them.

Antibiotic therapy

Peritonitis, spontaneous bacterial

1. Community-acquired Spontaneous Bacterial Peritonitis:^[1]

Preferred regimen (1): Cefotaxime 2 g IV Q 8 h for 5 days
Preferred regimen (2): Ceftriaxone 1 g IV bid for 5 days
Alternative regimen: If allergic to Penicillin give Levofloxacin 500 mg IV daily for 5 days

2. Nosocomial Spontaneous Bacterial Peritonitis:^[1]

Preferred regimen: Tazobactam–pipercillin 3.375 g IV Q 6 hrs AND Vancomycin 1 g IV Q 12 hrs for 5 days

3. Vancomycin-resistant Enterococcus Spontaneous Bacterial Peritonitis:^[1]

Preferred regimen: Linezolid 600 mg po or IV q12h OR Daptomycin 6 mg/kg IV

4. Extended spectrum beta-lactamase Enterobacteriaceae Spontaneous Bacterial Peritonitis(ESBL Enterobacteriaceae SBP):^[1]

Preferred regimen: Meropenem 1 g IV Q 8 h for 5-7 days

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 Dever JB, Sheikh MY (2015). "Review article: spontaneous bacterial peritonitis - bacteriology, diagnosis, treatment, risk factors and prevention". Aliment Pharmacol Ther. 41 (11): 1116–31. doi:10.1111/apt.13172. PMID 25819304.

Template:WikiDoc Sources

[pmid25819304-1] 1.0 ^1.1 ^1.2 ^1.3 Dever JB, Sheikh MY (2015). "Review article: spontaneous bacterial peritonitis - bacteriology, diagnosis, treatment, risk factors and prevention". Aliment Pharmacol Ther. 41 (11): 1116–31. doi:10.1111/apt.13172. PMID 25819304.

[1]

@@ Line 28: / Line 28: @@
 *'''4. Extended spectrum beta-lactamase Enterobacteriaceae Spontaneous Bacterial Peritonitis(ESBL Enterobacteriaceae SBP):'''<ref name="pmid25819304">{{cite journal| author=Dever JB, Sheikh MY| title=Review article: spontaneous bacterial peritonitis - bacteriology, diagnosis, treatment, risk factors and prevention. | journal=Aliment Pharmacol Ther | year= 2015 | volume= 41 | issue= 11 | pages= 1116-31 | pmid=25819304 | doi=10.1111/apt.13172 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25819304  }} </ref>
 :*Preferred regimen: [[Meropenem]] 1 g IV Q 8 h for 5-7 days
-| valign=top |
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Peritonitis '''
-</font>
-</div>
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-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Primary Spontaneous Bacterial'''''
-</font>
-</div>
-<div class="mw-customtoggle-table2" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Secondary '''''
-</font>
-</div>
-<div class="mw-customtoggle-table3" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Dialysis (CAPD) Associated  '''''
-</font>
-</div>
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table1" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Primary Spontaneous Bacterial }}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 2 gm IV q8h (q4h, if life-threatening infection) '''''<BR> OR <BR>▸'''''[[Ticaricillin Clavulanate]] 3.1 gm IV q6h '''''<BR> OR <BR>▸'''''[[Piperacillin Tazobactam]] 3.375 gm IV q6h (or 4-hour infusion of 3.375 gm q8h)'''''<BR> OR <BR>▸'''''[[Ceftriaxone]] 2 gm IV q24h'''''<BR> OR <BR>▸'''''[[Ertapenem]] 1 gm IV q24h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''If resistant [[E. coli]] or [[Klebsiella]] species'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Imipenem]] 500 mg IV q6h '''''<BR> OR <BR>▸'''''[[Meropenem]] 1000 mg IV q8h'''''<BR> OR <BR>▸'''''[[Doripenem]] 500 mg IV q8h (1 hr infusion)'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | ''''' If checking sensitivities, then start'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV q12h'''''<BR> OR <BR>▸'''''[[Levofloxacin]] 750 mg IV once daily'''''<BR> OR <BR>▸'''''[[Moxifloxacin]] 400 mg IV once daily'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''In addition to antibiotic, to decrease frequency of renal impairment start'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''IV [[Albumin]] 1.5 gm/kg at diagnosis and 1 gm/kg on day 3 '''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preventive regimen for chronic ascites'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[TMP-SMX-DS]] 1 tab po 5 days/week'''''<BR> OR <BR>▸'''''[[Ciprofloxacin]] 750 mg po once/week'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table2" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Secondary''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | ''''' For Mild/Moderate Peritonitis'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Piperacillin Tazobactam]] 3.375 gm IV '''''<br>▸'''''/ 4.5 gm IV q8h / 4-hr infusion of 3.375 gm q8h '''''  <BR> OR <BR>▸'''''[[Ticarcillin Clavulanate]] 3.1 gm IV q6h '''''<BR> OR <BR>▸'''''[[Ertapenem]] 1 gm IV q24h<BR> OR <BR>▸'''''[[Moxifloxacin]] 400 mg IV q24h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | ''''' For Severe Disease'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Imipenem]] 500 mg to 1 gm IV q6h '''''<BR> OR <BR> ▸'''''[[Meropenem]] 1 gm IV q8h'''''<BR> OR <BR>▸'''''[[Doripenem]] 500 mg IV q8h (1-hr infusion)'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | ''''' If Candida is suspected'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 200-400 mg po/IV once daily'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternate Regimen'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | ''''' For Mild/Moderate Disease'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV q12h''''' <BR> OR <BR>'''''▸ [[Levofloxacin]] 750 mg IV q24h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Metronidazole]] 1 gm IV q12h'''''<BR> OR <BR>▸ '''''[[Cefepime]] 2 gm q12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Metronidazole]] 1 gm IV q12h'''''<BR> OR <BR> ▸ '''''[[Tigecycline]] 100 mg IV x 1 dose, then 50 mg q12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | ''''' For Severe Disease'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]]I.M., I.V.: 1-2 g every 4-6 hours or 50-250 mg/kg/day in divided doses (maximum: 12 g/day) '''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ Metronidazole]]I.V.: 500 mg every 8-12 hours or 1.5 g every 24 hours for for 4-7 days'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV q8h''''' <BR> OR <BR> ▸'''''[[Levofloxacin]] 750 mg IV q24h'''''<BR> OR <BR>
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 gm IV q6h '''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ Metronidazole]] 1200 mg IV q12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aminoglycoside]]'''''
-|-
-|}
-|}
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table3" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Dialysis (CAPD) Associated ''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Gram-positive cocci'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ Vancomycin]]I.V.: 2000-3000 mg daily (or 30-60 mg/kg/day) in divided doses every 8-12 hours'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Gram-negative bacilli'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] I.V.: 2 g every 12 hours for 7-10 days. ''''' <br>OR<br>▸''''' [[Ceftazidime]] .V.: 2 g every 8 hours for 4-7 days '''''  <br>OR<br> ▸'''''[[carbapenem]]  '''''<br>OR<br>▸'''''[[Aztreonam]] 1 g I.V. or I.M. or 2 g I.V. every 8-12 hours'''''<br>OR<br>▸''''[[Ciprofloxacin]] I.V.: 400 mg every 12 hours for 7-14 days'''''<br>OR<br>▸'''''[[Gentamicin]]  3 mg/kg/day in 1-3 divided doses'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Add an antifungal only if yeast seen on Gram-stain '''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Continuous therapy until culture results available '''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Beta-lactam]] continuous therapy ''''' <br>OR<br>▸'''''[[Aminoglycoside]]''''' intermittent therapy]] '''''
-|-
-|}
-|}
-|}
 ==References==