[Stage-oriented antibiotic therapy of peritonitis. Prospective study].
METHODS
In a prospective protocol 25 consecutive patients with diffuse peritonitis were treated in the Surgical Clinic of the RWT-University in Aachen, Germany, from January to December 1995. According to the "Mannheim Peritonitis Score" three different stages were treated with different surgical procedures and a selective antibiotic regimen. Group-A patients with prognostically favorable peritonitis (MPS 0-20) were treated with the so-called standard procedure, group-B patients (MPS: 21-29) with closed postoperative lavage. The antibiotic regimen was cefotaxime (2 x 2 g) and metronidazole (2 x 500 mg) for both group-A and group-B patients. Severe group-C cases (MPS > 29) were treated with the so-called Etappenlavage (multiple reexplorations and intra-operative lavage) and received a combination of three antibiotics (2 x 2 g cefotaxime; 2 x 500 mg metronidazole and 2 x 200 mg ofloxacin).


RESULTS
Eight patients belonged to group A, 10 to group B, and 7 to group C. The mortality was 0% (group A), 20% (group B), and 29% (group C), respectively. The actual overall mortality of the whole group was 16% (4/25). The statistically expected mortality was 36%, according to the APACHE-II-Score (P = 0.0982).
Winkeltau
G J
GJ
Chirurgische Universitätsklinik der RWTH, Aachen.
Töns
C
C
Bertram
P
P
Schumpelick
V
V
D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001424:Bacterial Infections / Q000145:classification / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D002439:Cefotaxime / Q000008:administration & dosage* / Q000009:adverse effects; D002511:Cephalosporins / Q000008:administration & dosage* / Q000009:adverse effects; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage* / Q000009:adverse effects; D015242:Ofloxacin / Q000008:administration & dosage* / Q000009:adverse effects; D010533:Peritoneal Lavage; D010538:Peritonitis / Q000145:classification / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000145:classification / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D016019:Survival Analysis
D000890:Anti-Infective Agents; D002511:Cephalosporins; D008795:Metronidazole; D015242:Ofloxacin; D002439:Cefotaxime