From the Guidelines
The diagnosis and treatment of peritonitis, which is the inflammation of the peritoneum, should be approached with immediate empirical antibiotic therapy and source control, as the condition can lead to severe morbidity and mortality if not managed promptly and effectively. The management of peritonitis involves classifying it into primary, secondary, or tertiary peritonitis, with secondary peritonitis being the most common form, resulting from loss of integrity of the gastrointestinal tract or from infected viscera 1.
Diagnosis and Classification
Peritonitis is diagnosed based on clinical presentation, laboratory findings, and imaging studies. The classification of peritonitis into primary, secondary, or tertiary helps guide the treatment approach. Primary peritonitis is a diffuse bacterial infection without an identifiable source of infection, secondary peritonitis is caused by perforation of the gastrointestinal tract or direct invasion from infected intra-abdominal viscera, and tertiary peritonitis is a recurrent infection of the peritoneal cavity following primary or secondary peritonitis 1.
Treatment Approach
The treatment of peritonitis involves both source control and antibiotic therapy. Source control is crucial and should be achieved as soon as possible, either through surgical or non-surgical means, to eliminate the source of infection and reduce the bacterial inoculum. Empirical antibiotic therapy must be initiated immediately after diagnosis, with the choice of antibiotics depending on the severity of the infection, the environment (community-acquired, healthcare-associated, or nosocomial), and local resistance profiles 1.
Antibiotic Therapy
For community-acquired peritonitis, antibiotics such as cefotaxime or amoxicillin/clavulanic acid may be used, while for healthcare-associated or nosocomial peritonitis, broader-spectrum antibiotics like piperacillin/tazobactam, meropenem, or combinations including glycopeptides or daptomycin may be necessary due to the higher risk of multi-drug resistant organisms (MDROs) 1. The duration of antibiotic therapy should be tailored to the individual patient's response, with a minimum of 5 days for uncomplicated cases and longer for complicated cases or those with a slow response to treatment.
Source Control Measures
Source control measures include drainage of abscesses or infected fluid collections, debridement of necrotic or infected tissues, and definitive control of the source of contamination. This can be achieved through surgical intervention, such as resection or suture of a diseased or perforated viscus, removal of the infected organ, or non-surgical means like percutaneous drainage of abscesses under ultrasound or CT guidance 1. Laparoscopy is also gaining acceptance in the diagnosis and treatment of intra-abdominal infections, offering a less invasive approach, but its use must be carefully considered, especially in critically ill patients due to potential effects on cardiovascular and pulmonary physiology 1.
Monitoring and Adjustment
It is essential to monitor the patient's response to treatment closely, with adjustments made as necessary. If the ascitic fluid neutrophil count fails to decrease appropriately after two days of treatment, further evaluation and potential modification of the antibiotic regimen or source control measures are necessary 1.
In summary, the management of peritonitis requires a prompt and comprehensive approach, including immediate empirical antibiotic therapy and source control, tailored to the individual patient's condition and the local epidemiology of antibiotic resistance.
From the Research
Diagnosis of Peritonitis
There are no research papers to assist in answering this question as the provided studies do not discuss the diagnosis of peritonitis.
Treatment of Peritonitis
There are no research papers to assist in answering this question as the provided studies do not discuss the treatment of peritonitis. The studies provided focus on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and other medications for pain and inflammation management, but do not specifically address peritonitis.
- The studies discuss the mechanism of action, benefits, and risks of NSAIDs 2, 3, 4, 5, 6
- They also discuss the use of acetaminophen, selective COX-2 inhibitors, and other medications for pain management 2, 3, 4, 5, 6
- However, none of the studies provide information on the diagnosis or treatment of peritonitis.