Peritonitis medical therapy: Difference between revisions

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{{CMG}}
{{CMG}} ;{{AE}} {{chetan}}
==Medical Therapy==
==Medical Therapy==
Depending on the severity of the patient's state, the management of peritonitis may include:
Depending on the severity of the patient's state, the management of peritonitis may include:
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<div class="mw-customtoggle-table1" 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">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Dialysis (CAPD) Associated '''''
&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Primary Spontaneous Bacterial'''''
</font>
</font>
</div>
</div>
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<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">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Primary Spontaneous Bacterial '''''
&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Dialysis (CAPD) Associated  '''''
</font>
</font>
</div>
</div>


{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table1" style="background: #FFFFFF;"
| valign=top |
| valign=top |
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table1" style="background: #FFFFFF;"
{| 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'''''
|}
|}
| valign=top |
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table3" style="background: #FFFFFF;"
| valign=top |
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Mild/Moderate Peritonitis'''''
| 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>OR ▸'''''4.5 gm IV q8h''''' <BR>OR ▸'''''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="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 | '''''Severe Disease'''''
| 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="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)'''''
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternate Regimen'''''
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternate Regimen'''''
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Mild/Moderate Disease'''''
| 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="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="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | PLUS
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| 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="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 | '''''Severe Disease'''''
| 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]] '''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] '''''
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | PLUS
| 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'''''
| 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="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 gm IV q6h '''''
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aminoglycoside]]'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aminoglycoside]]'''''
|-
|-
|}
|}
{| 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|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, 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 | '''''Check sensitivities'''''
|-
| 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'''''
|-
| 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 to decrease frequency of renal impairment'''''
|-
| 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'''''
|}
|}
|}
|}

Revision as of 19:50, 5 February 2014

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.

Antibiotic therapy

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


References


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