TAILIEUCHUNG - Chapter 121. Intraabdominal Infections and Abscesses (Part 4)

Secondary Peritonitis: Treatment Treatment for secondary peritonitis includes early administration of antibiotics aimed particularly at aerobic gram-negative bacilli and anaerobes (see below). Mild to moderate disease can be treated with many drugs covering these organisms, including broad-spectrum penicillin/β-lactamase inhibitor combinations (., ticarcillin/clavulanate, g q4–6h IV) or cefoxitin (2 g q4–6h IV). Patients in intensive care units should receive imipenem (500 mg q6h IV), meropenem (1 g q8h IV), or combinations of drugs, such as ampicillin plus metronidazole plus ciprofloxacin. The role of enterococci and Candida spp. in mixed infections is controversial. . | Chapter 121. Intraabdominal Infections and Abscesses Part 4 Secondary Peritonitis Treatment Treatment for secondary peritonitis includes early administration of antibiotics aimed particularly at aerobic gram-negative bacilli and anaerobes see below . Mild to moderate disease can be treated with many drugs covering these organisms including broad-spectrum penicillm 0-lactamase inhibitor combinations . ticarcillin clavulanate g q4-6h IV or cefoxitin 2 g q4-6h IV . Patients in intensive care units should receive imipenem 500 mg q6h IV meropenem 1 g q8h IV or combinations of drugs such as ampicillin plus metronidazole plus ciprofloxacin. The role of enterococci and Candida spp. in mixed infections is controversial. Secondary peritonitis usually requires both surgical intervention to address the inciting process and antibiotics to treat early bacteremia to decrease the incidence of abscess formation and wound infection and to prevent distant spread of infection. While surgery is rarely indicated in PBP in adults it may be life-saving in secondary peritonitis. Peritonitis may develop as a complication of abdominal surgeries. These infections may be accompanied by localizing pain and or nonlocalizing symptoms such as fever malaise anorexia and toxicity. As a nosocomial infection postoperative peritonitis may be associated with organisms such as staphylococci components of the gram-negative hospital microflora and the microbes that cause PBP and secondary peritonitis as described above. Peritonitis in Patients Undergoing CAPD A third type of peritonitis arises in patients who are undergoing continuous ambulatory peritoneal dialysis CAPD . Unlike PBP and secondary peritonitis which are caused by endogenous bacteria CAPD-associated peritonitis usually involves skin organisms. The pathogenesis of infection is similar to that of intravascular device-related infection in which skin organisms migrate along the catheter which both serves as an entry point and exerts the .

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• Preventing Morbidity
• Multidisciplinary Care