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 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:
- Control the infectious source
- Eliminate bacteria and toxins
- Maintain organ system function
- Control the inflammatory process
Depending on the severity of the patient's state, the management of secondary 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.
- The response to therapy can be documented, if necessary, by a decrease in the PMN count of at least 50% on repeat paracentesis 48 hours after initiation of therapy.
- Probiotic supplement (containing Lactobacillus acidophilus among other species), 5 - 10 billion CFUs (colony forming units) a day, for gastrointestinal and immune health.
- Probiotics can be especially helpful when taking antibiotics, because probiotics can help restore the balance of "good" bacteria in the intestines.
References
- ↑ 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.