Definition
In the medical field, the term peritonitis refers to an acute infectious-inflammatory process affecting the peritoneum, the membranous lining that covers the abdominal cavity and the organs it contains. When left untreated, peritonitis can be fatal.
Causes
Following the perforation of an organ contained in the abdominal cavity, it is possible to witness a bacterial or fungal proliferation, responsible for a contamination of the peritoneum. In some cases, peritonitis is a direct complication of serious pathologies. Peritonitis can also result from continued irritation from contact with gastric juices.
Risk factors for peritonitis: appendicitis, cirrhosis, ulcerative colitis, diverticulitis, gallbladder diseases, intestinal obstruction
Symptoms
The severity of the symptoms depends on the violence with which the inflammation occurs; in case of primary peritonitis, the subject complains of abdominal pain and swelling, fever and loss of appetite. The acute secondary form is more violent: diarrhea, difficulty in urinating, dehydration, emesis , high fever, severe abdominal cramps, bloating, oliguria, abdominal muscle stiffness, intense thirst and dark urine.
Severe complications: hypovolemic shock and patient death
The information on Peritonitis - Medicines for the Treatment of Peritonitis is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Peritonitis - Medicines to Treat Peritonitis.
Medicines
For the treatment of acute peritonitis proliferative, the patient is generally subjected to surgery, associated with a powerful antibiotic therapy; the intervention involves the removal of the source of contamination or, in other cases, the removal of the entire infected organ.
Treatment for acute peritonitis without proliferation bacterial essentially involves the administration of antibiotics, in addition to respiratory therapy and hydration by intravenous infusion of electrolytes and fluids, lost due to vomiting and diarrhea.
The following are the classes of drugs most used in the therapy against peritonitis, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment:
Aminoglycosides:
- Amikacin (eg Chemacin, Mikan, Likacin) the administration of this antibiotic drug is indicated for the treatment of peritonitis associated with peritoneal dialysis. For patients on continuous ambulatory peritoneal dialysis (CADP), inject 24 mg / L intraperitoneally (for subjects with anuria) and 30 mg / L for non-anuric patients. For patients on intermittent peritoneal dialysis, the posology is different: 2 mg / kg per exchange per day for anuric patients and 2.5 mg / kg for non-anuric patients. Do not exceed 1.5 grams per day.
- Gentamicin (eg. Gentamicin, Ciclozinil, Genbrix, Gentalyn): for patients on CADP, the recommended dose of drug is 0.6-0.75 mg / kg intraperitoneally, once a day or 16-20 mg every 2 liters of dialysis fluid. Alternatively, take the drug intravenously: 2 mg per kilo (loading dose), followed by 1.7 mg / kg i.v. every 8 hours or 5 mg / kg i.v. every 24 hours. Therapy is generally continued for 14 days. After stabilization of the patient, intravenous therapy can be converted to oral therapy.
- Tobramycin (eg Tobi Podhaler, Bramicil, Nebicina) indicated for the treatment of peritonitis associated with chronic lung diseases caused by Pseudomonas aeruginosa. Intravenously, the recommended dose is 2 mg / kg (loading dose), followed by 1.7 mg / kg i.v., every 8 hours or 5 mg / kg i.v. every 24 hours. In general, the duration of therapy is 14 days. For patients on CADP, the recommended drug dose is 0.6-0.75 mg / kg intraperitoneally once daily or 16-20 mg per 2 liters of dialysis fluid.
Cephalosporins: these antibiotics, especially of the third generation, are the drugs of choice for the treatment of bacterial peritonitis
- Cefazolin (eg. Cefazolin GRP, Cefazil, Nefazol) first generation cephalosporin. It is recommended to take the drug at a dosage of 1-2 g i.v. every 6-8 hours. Do not exceed 12 grams per day. The duration of therapy is generally 2 weeks.
- Cefuroxime (eg. Cefoprim, Tilexim, Zoref, Zinnat): second generation cephalosporin. Take the drug at a dosage of 750-1500 mg intravenously every 8 hours, for 10-14 days. For CAPD patients in the setting of peritonitis, take 1 gram for every 2 liters of dialysis fluid intraperitoneally followed by a maintenance dose of 150-400 mg per 2 liters of dialysis fluid thereafter.
- Cefotaxime (eg. Cefotaxime, Aximad, Lirgosin): third generation cephalosporin. Take 1-2 grams i.v. every 6-8 hours. Do not exceed 2 grams i.v. every 4 hours. The duration of therapy is between 5 and 14 days. For patients on dialysis in the setting of peritonitis, the recommended dose is 500 mg per 2 liters of intraperitoneal dialysis fluid (for continuous CADP), or 2g / liter of dialysis fluid for individuals on intermittent peritoneal dialysis.
- Ceftriaxone (eg. Ceftriaxone, Pantoxon, Ragex, Deixim) third generation cephalosporin. Take the drug at a dosage of 2 grams intravenously once a day, for 10-14 days. For patients on continuous dialysis, take 1 g / 2 liters of intraperitoneal dialysis fluid, followed by 250-500 mg on 2 liters of fluid. In case of intermittent peritoneal dialysis, inject 1 gram per 2 liters of dialysis fluid every 24 hours, again intraperitoneally.
For the treatment of fungal peritonitis
Fluconazole (eg Diflucan): indicated to treat peritonitis caused by fungi such as Candida albicans. Take 50-200 mg of the drug orally or intravenously once a day. The duration of treatment must be determined by the doctor.
Therapeutic schemes for the treatment of peritonitis
Here are some examples of therapeutic schemes: the doctor chooses the most suitable combination of antibiotics to treat peritonitis, based on the associated diseases, the bacterium responsible and the patient's response to the treatment. The dosage and duration of treatment are established by the doctor.
- Clavulanic acid + Amoxicillin (eg Clavulin, Augmentin) to be taken intravenously
- Quinolones (eg. Norfloxacin: eg. Norflox, Flossac, Sebercim; Ciprofloxacin: eg. Ciprofloxac, Samper, Ciproxin, Kinox): indicated to prevent peritonitis in patients at risk (suffering from cirrhosis)
- Cephalosporins + Metronidazole (eg. Metronid, Deflamon, Flagyl)
- Vancomycin (eg. Vancocin, Zengac, Maxivanil) + Ceftazidime (eg. Etazim, Liotixil, Fribat): for peritonitis associated with peritoneal dialysis
- Vancomycin (added to dialysis fluid) + Ciprofloxacin (to be taken orally. Eg Ciprofloxac, Samper, Ciproxin, Kinox): for peritonitis associated with peritoneal dialysis
- Ticarcillin + clavulanic acid (eg Clavucar, Timentin): it is recommended to take 3.1 grams intravenously every 4-6 hours. The duration of therapy for the treatment of peritonitis varies from 1 to 2 weeks depending on the nature of the infection.
