Duration of antibiotic treatment in surgical infections of the abdomen. Postoperative peritonitis.
Postoperative peritonitis is potentially lethal and is usually caused by leakage of gut contents. Successful management depends on early diagnosis and treatment which require clinical suspicion and aggressive diagnostic imaging. Treatment consists of fluid and nutritional resuscitation, peritoneal toilet, control of gut leakage and initiation of antimicrobial therapy. Since delay in diagnosis is common, antimicrobial treatment is usually begun when the infection has become well developed. Experimental evidence has shown that in some settings antimicrobial agents do not perform as well in later stages of infection but whether this applies to peritonitis is not known. The optimal duration of antimicrobial therapy has not been studied specifically in postoperative peritonitis. Arguments for prolonged treatment include the potential for greater killing of bacteria in patients who have severe infections. Arguments against prolongation of therapy include the lesser role of antibiotics compared with operative management, doubt about the value of antibiotics' ability to kill bacteria at later stages of infection and the significant number of infective and non-infective complications of drug therapy. Limitation of antimicrobial treatment to no more than seven days is advocated. Persistent clinical signs, fever, or leucocytosis should prompt a search for a drainable focus of infection in the abdomen or treatable site elsewhere.
Department of Surgery, Wellesley Hospital, Toronto, Canada.
J M
JM
Bohnen
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D006801:Humans; D010538:Peritonitis / Q000188:drug therapy*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000188:drug therapy*; D013997:Time Factors
D000900:Anti-Bacterial Agents