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]

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.

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

The treatment of peritonitis is multidisciplinary, with the complimentary application of medical, operative and nonoperative interventions. Medical support includes the following:

• Systemic antibiotic therapy
• Intensive care with hemodynamic, pulmonary, and renal support
• Correction of electrolyte and coagulation abnormalities
• Nutrition and metabolic support
• Inflammatory response modulation therapy

Critical aspects of treatment should focus on:

• Early operative approach in order to identify the source of peritonitis
• Clearing of the infection in the peritoneal cavity by means of lavage, adequate drainage, and antibiotics
• Intubation and decompression of GI tract and control of paralytic ileus.
• Metabolic correction (acid-base balance, serum electrolytes, protein metabolism)
• Restoration and support of visceral function (kidney, liver, lung, heart) and prevention of complications.

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 colony forming units (CFUs) a day, for gastrointestinal and immune health.
• Probiotics can be especially helpful when taking antibiotics because probiotics can help restore the balance of bacterial flora in the intestines.

Template:WikiDoc Sources