From the Guidelines
The patient H.613 A | RATHBUN DORISBETH should be started on broad-spectrum IV antibiotics immediately, such as piperacillin-tazobactam 3.375g IV every 6 hours, and should remain NPO in preparation for urgent surgical intervention. The clinical presentation of perforated diverticulitis and pneumoperitoneum, along with a low-grade fever of 100.7°F orally, necessitates prompt medical and surgical management to prevent complications such as sepsis and further peritonitis 1.
Medical Management
The choice of antibiotic regimen should be based on the severity of infection, presumed pathogens, and local resistance patterns, with consideration for coverage against Gram-positive, Gram-negative bacteria, and anaerobes 1. Given the risk of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae in community-acquired infections, anti-ESBL-producer coverage is warranted 1. IV fluids should be administered for hydration, and pain management should be provided as needed, typically with medications such as morphine or hydromorphone.
Surgical Preparation
The patient should continue to be NPO as directed for surgical preparation. Close monitoring of vital signs, including temperature trends, is crucial, and laboratory studies such as complete blood count with differential, comprehensive metabolic panel, and blood cultures should be obtained if not already done. The surgical team should be updated about the patient's condition, including the fever, as this may influence surgical timing or approach.
Outcome Prioritization
The management plan prioritizes reducing morbidity and mortality by promptly addressing the infection and preparing the patient for surgery, while also considering the quality of life by providing adequate pain management and hydration. The goal is to prevent the progression to sepsis and peritonitis, which can significantly impact the patient's outcome 1.
From the Research
Patient Condition
The patient, RATHBUN DORISBETH, is being treated for perforated diverticulitis and pneumoperitoneum, and is currently NPO (nil per os) in preparation for surgery. The patient has a temperature of 100.7°F orally.
Treatment Considerations
- The patient's condition requires immediate attention to prevent further complications from the infection.
- According to 2, timely pharmacological management is crucial in recovering from peritonitis and preventing complications.
- The choice of antibiotic therapy is critical, and should be guided by the suspected pathogens and their bacteriologic susceptibilities, as stated in 3.
- Studies such as 4 and 5 suggest that broad-spectrum antibiotics, including ceftriaxone, metronidazole, and piperacillin/tazobactam, may be effective in treating bacterial peritonitis.
Antibiotic Therapy Options
- Ceftriaxone plus metronidazole has been shown to be an efficient and easily administered antibiotic regimen in patients with bacterial peritonitis, as demonstrated in 4.
- Imipenem, piperacillin/tazobactam, and tigecycline are also viable options for empiric therapy, according to 5.
- The choice of antibiotic should take into account the patient's allergy history, as well as the local epidemiology and resistance patterns, as emphasized in 3.
Additional Considerations
- The patient's temperature of 100.7°F orally indicates the presence of an infection, and antibiotic therapy should be initiated promptly.
- The patient's NPO status in preparation for surgery should not delay the initiation of antibiotic therapy, as the infection requires immediate attention.
- Further evaluation and monitoring of the patient's condition are necessary to ensure the effectiveness of the chosen antibiotic therapy and to prevent any potential complications.