Secondary peritonitis medical therapy

Peritonitis main page
Secondary Peritonitis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Secondary peritonitis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History & Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Secondary peritonitis medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Secondary peritonitis medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Secondary peritonitis medical therapy
CDC on Secondary peritonitis medical therapy
Secondary peritonitis medical therapy in the news
Blogs on Secondary peritonitis medical therapy
Directions to Hospitals Treating Spontaneous bacterial peritonitis
Risk calculators and risk factors for Secondary peritonitis medical therapy

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.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.

Empirical treatment for Secondary Peritonitis
Empiric antibiotic therapy	Empiric antifungal therapy
Mild or moderate secondary peritonitis Ertapenem 1gm IV Q24H Penicillin allergic patients: Ciprofloxacin 400mg IV Q12H + Metronidazole 500mg IV Q8H Severe peritonitis or Immunocompromised patients Piperacillin/ tazobactam 3.375gm IV Q6H Penicillin allergic patient: Cefepime 1gm IV Q8H + Metronidazole 500gm IV Q8H Severe PCN allergic patient: Vancomycin + Aztreonam 1gm IV Q8H or Ciprofloxacin 400mg IV Q8H + Metronidazole 500mg IV Q8H Duration of empiric therapy depends on whether the peritonitis is complicated or uncomplicated: Uncomplicated: Perforation is operated with in 12-24 hours Duration of empiric therapy: 24-48 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 excepet if the patient has one of the following risk factors: Esophageal perforation Immunosuppression Prolonged antacid therapy Prolonged antibiotic therapy Prolonged hospitalization Persistant GI leak 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 therpy: Micafungin 100mg IV Q24H References Template:WikiDoc Sources