Peritonitis medical therapy

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

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

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.

Peritonitis

▸ Primary Spontaneous Bacterial

▸ Secondary

▸ Dialysis (CAPD) Associated

Primary Spontaneous Bacterial
Preferred Regimen
▸ Cefotaxime 2 gm IV q8h (q4h, if life-threatening infection) OR ▸Ticaricillin Clavulanate 3.1 gm IV q6h OR ▸Piperacillin Tazobactam 3.375 gm IV q6h (or 4-hour infusion of 3.375 gm q8h) OR ▸Ceftriaxone 2 gm IV q24h OR ▸Ertapenem 1 gm IV q24h
If resistant E. coli or Klebsiella species
▸ Imipenem 500 mg IV q6h OR ▸Meropenem 1000 mg IV q8h OR ▸Doripenem 500 mg IV q8h (1 hr infusion)
If checking sensitivities, then start
▸ Ciprofloxacin 400 mg IV q12h OR ▸Levofloxacin 750 mg IV once daily OR ▸Moxifloxacin 400 mg IV once daily
In addition to antibiotic, to decrease frequency of renal impairment start
▸IV Albumin 1.5 gm/kg at diagnosis and 1 gm/kg on day 3
Preventive regimen for chronic ascites
▸TMP-SMX-DS 1 tab po 5 days/week OR ▸Ciprofloxacin 750 mg po once/week

Dialysis (CAPD) Associated
Gram-positive cocci
▸ Vancomycin
Gram-negative bacilli
▸ Cefepime OR ▸ Ceftazidime OR ▸carbapenem OR ▸Aztreonam OR ▸'Ciprofloxacin OR ▸Gentamicin
▸ Add an antifungal only if yeast seen on Gram-stain
▸ Continuous therapy until culture results available
▸ Beta-lactam continuous therapy OR ▸Aminoglycoside intermittent therapy]]

Secondary
Preferred Regimen
For Mild/Moderate Peritonitis
▸ Piperacillin Tazobactam 3.375 gm IV ▸/ 4.5 gm IV q8h / 4-hr infusion of 3.375 gm q8h OR ▸Ticarcillin Clavulanate 3.1 gm IV q6h OR ▸Ertapenem 1 gm IV q24h OR ▸Moxifloxacin 400 mg IV q24h
For Severe Disease
▸ Imipenem 500 mg to 1 gm IV q6h OR ▸Meropenem 1 gm IV q8h OR ▸Doripenem 500 mg IV q8h (1-hr infusion)
If Candida is suspected
▸ Fluconazole 200-400 mg po/IV once daily
Alternate Regimen
For Mild/Moderate Disease
▸ Ciprofloxacin 400 mg IV q12h OR ▸ Levofloxacin 750 mg IV q24h
PLUS
▸ Metronidazole 1 gm IV q12h OR ▸ Cefepime 2 gm q12h
PLUS
▸ Metronidazole 1 gm IV q12h OR ▸ Tigecycline 100 mg IV x 1 dose, then 50 mg q12h
For Severe Disease
▸ Ampicillin
PLUS
▸ Metronidazole
PLUS
▸ Ciprofloxacin 400 mg IV q8h OR ▸Levofloxacin 750 mg IV q24h OR
▸ Ampicillin 2 gm IV q6h
PLUS
▸ Metronidazole 1200 mg IV q12h
PLUS
▸ Aminoglycoside