PERITONITIS

DESCRIPTION

Infection of the peritoneum, usually secondary to a surgical cause such as perforated bowel. In this setting polymicrobial infection with anaerobes and Enterobacteriaceae are usually found.

Primary or spontaneous bacterial peritonitis is much less common and usually complicates ascites in patients with portal hypertension. This is not usually polymicrobial but due generally to Enterobacteriaceae such as E.

coli. Spontaneous bacterial peritonitis is often culture-negative but is diagnosed by ascitic neutrophil count >0.25 x 109/L (250 cells/mm3).

GENERAL MEASURES

Secondary peritonitis

Intravenous fluids and nasogastric suction.

Prompt surgical intervention is essential.

MEDICINE TREATMENT

Empiric antibiotic therapy

For surgical causes of peritonitis:

• Benzylpenicillin (penicillin G), IV, 2 million units every 6 hourly.

PLUS

• Gentamicin, IV, 6 mg/kg daily.

PLUS

• Metronidazole, IV, 500 mg 8 hourly.

As soon as patient can tolerate oral medication:

• Metronidazole, oral, 400 mg 8 hourly.

For spontaneous bacterial peritonitis:

• Ceftriaxone, IV, 1 g daily.

Switch to oral therapy when clinically appropriate according to culture or

treat with:

• Ciprofloxacin, oral, 500 mg 12 hourly.

o Total duration of therapy: 14 days.

Reference and further reading

Standard Treatment Guidelines and Essential Medicines List for South Africa 2012 Edition