Secondary peritonitis medical therapy

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

Overview

Medical management of secondary peritonitis includes hydration, prevention of septicemia, and correction of electrolytes. Empiric coverage for gram positive, gram negative and anaerobic bacteria should be initiated promptly while awaiting culture results. Either open abdominal surgery or an exploratory laparotomy is recommended.

Medical Therapy

For secondary peritonitis appropriate use of antimicrobial regimen, serves as an adjunctive treatment to surgical intervention.[1]The general principles guiding the treatment of secondary peritonitis are 4-fold, as follows:

The treatment of peritonitis is multidisciplinary, with the complimentary application of medical, operative and nonoperative interventions. Medical support includes the following:

Critical aspects of treatment should focus on:

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

Empirical treatment for Secondary Peritonitis
Empiric antibiotic therapy[2] Empiric antifungal therapy

Mild or moderate secondary peritonitis

Severe peritonitis or Immunocompromised patients


Duration of empiric therapy depends on whether the peritonitis is complicated or uncomplicated:

Uncomplicated: Perforation is operated within 12-24 hours

Complicated: Perforation is operated lately or necrotic/gangrenous appendix is developed.

  • Duration of empiric therapy: 4 days unless adequate source control is not achieved.

Emperical antifungal therapy is generally indicated in secondary peritonitis except if the patient has one of the following risk factors:

If the patient is clinically stable and no history of prior long term azole therpy: Fluconazole 400-800 mg IV/PO Q24H

If the patient is clinically unstable or patient with history of prior long-term azole therapy: Micafungin 100mg IV Q24H

References

  1. Bosscha K, van Vroonhoven TJ, van der Werken C (1999). "Surgical management of severe secondary peritonitis". Br J Surg. 86 (11): 1371–7. doi:10.1046/j.1365-2168.1999.01258.x. PMID 10583280.
  2. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al. (2010) Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Surg Infect (Larchmt) 11 (1):79-109. DOI:10.1089/sur.2009.9930 PMID: 20163262


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