Peritonitis medical therapy
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Peritonitis Main Page |
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.