Treatment Overview

Peritonitis is a serious medical condition characterized by inflammation of the thin layer of tissue that lines the inside of the abdomen. For patients, the experience is often defined by severe abdominal pain, tenderness, and a rigid, swollen belly that makes movement agonizing. This condition frequently requires hospitalization, which can be sudden and frightening for both the patient and their loved ones. Whether caused by liver disease or a rupture in an abdominal organ, the symptoms demand immediate attention to prevent life-threatening complications.

Treatment is critical to halt the spread of infection throughout the body, a state known as sepsis. The primary goal is to eliminate the bacteria or fungus causing the inflammation and to stabilize the body’s vital functions. Because peritonitis can arise from different causes such as Spontaneous Bacterial Peritonitis (SBP) in liver patients or secondary peritonitis from a burst appendix, treatment plans are tailored to the specific source of the infection and the patient’s overall health stability (Mayo Clinic, 2023).

Overview of treatment options for Peritonitis

The management of peritonitis is aggressive and almost always begins in a hospital setting. The immediate priorities are to fight the infection and manage severe pain. Pharmacological treatment is the cornerstone of care, often starting intravenously (IV) to ensure rapid delivery of medication into the bloodstream.

For cases of secondary peritonitis (caused by a rupture), surgery is typically required to repair the underlying issue, but medications are essential before and after the procedure to control the infection. For SBP, medication is usually the primary treatment without the need for surgery. Clinical experience suggests that the prompt administration of broad-spectrum antibiotics, even before the specific bacteria is identified, is crucial for positive outcomes.

Medications used for Peritonitis

Antibiotics are the first-line defense for bacterial peritonitis. Initially, doctors prescribe “empiric” therapy, which involves broad-spectrum antibiotics capable of fighting a wide range of bacteria. Once lab results identify the specific organism, the medication may be adjusted.

  • Cephalosporins: Third-generation cephalosporins, such as cefotaxime or ceftriaxone, are frequently the drug of choice, particularly for spontaneous bacterial peritonitis. They are effective against common gram-negative bacteria.
  • Penicillins combined with Beta-Lactamase Inhibitors: Drugs like piperacillin-tazobactam are often used for more complex or severe infections to overcome bacterial resistance.
  • Carbapenems: In cases of severe hospital-acquired infections or multi-drug resistance, potent antibiotics like meropenem may be utilized.

If the infection is caused by a fungus (Candida), which is less common but possible in patients on peritoneal dialysis or with perforated ulcers, antifungal medications are prescribed.

  • Antifungals: Fluconazole or echinocandins (like micafungin) are standard options to target fungal overgrowth.

Pain management is also a critical component of medication therapy.

  • Analgesics: Due to the severity of the pain, doctors may prescribe opioid analgesics (such as morphine or hydromorphone) to keep the patient comfortable.

Patients typically receive antibiotics via IV for several days before switching to oral medications as they recover. Improvement in fever and pain is often seen within 48 to 72 hours of starting effective therapy (National Institute of Diabetes and Digestive and Kidney Diseases, 2021).

How these medications work

Antibiotics fight infection by disrupting bacterial vital processes. Classes like cephalosporins and penicillins destroy the bacterial cell wall, causing rupture and death. Others hinder protein production, stopping growth and replication. By reducing abdominal bacterial load, they halt toxin production that causes inflammation and shock.

Antifungals similarly target fungal cell structures, like their distinct cell membranes. Analgesics block pain signals in the central nervous system, promoting essential rest and healing (MedlinePlus, 2022).

Side effects and safety considerations

Strong antibiotics/antifungals often cause nausea, diarrhea, and stomach upset, plus the risk of severe C. difficile infection. High doses or long-term use can damage the kidneys and liver, necessitating strict blood test monitoring of organ function, especially in patients with existing liver disease.

Opioid pain medications cause sedation, dizziness, and constipation, requiring close monitoring of breathing and bowel function. Patients must seek immediate medical attention if symptoms return or if they show signs of an allergic reaction (e.g., rash, swelling).

Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.

References

  1. Mayo Clinic. https://www.mayoclinic.org
  2. MedlinePlus. https://medlineplus.gov
  3. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov
  4. Merck Manuals. https://www.merckmanuals.com

Medications for Peritonitis

These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Peritonitis.

Found 10 Approved Drugs for Peritonitis

Ceftazidime

Brand Names
Tazicef, Avycaz

Ceftazidime

Brand Names
Tazicef, Avycaz
Form: Injection, Powder
Method of administration: Intravenous, Intramuscular
FDA approval date: November 02, 2005
Classification: Cephalosporin Antibacterial
Tazicef (ceftazidime for injection) is indicated for the treatment of patients with infections caused by susceptible strains of the designated organisms in the following diseases: 1. Lower Respiratory Tract Infections, including pneumonia, caused by Pseudomonas aeruginosa and other Pseudomonas spp.; Haemophilus influenzae, including ampicillin-resistant strains; Klebsiella spp.; Enterobacter spp.; Proteus mirabilis ; Escherichia coli ; Serratia spp.; Citrobacter spp.; Streptococcus pneumoniae ; and Staphylococcus aureus (methicillin-susceptible strains). 2. Skin and Skin-Structure Infections caused by Pseudomonas aeruginosa ; Klebsiella spp.; Escherichia coli ; Proteus spp., including Proteus mirabilis and indole-positive Proteus ; Enterobacter spp.; Serratia spp.; Staphylococcus aureus (methicillin-susceptible strains); and Streptococcus pyogenes (group A beta-hemolytic streptococci). 3. Urinary Tract Infections, both complicated and uncomplicated, caused by Pseudomonas aeruginosa ; Enterobacter spp.; Proteus spp., including Proteus mirabilis and indole-positive Proteus ; Klebsiella spp.; and Escherichia coli. 4. Bacterial Septicemia caused by Pseudomonas aeruginosa, Klebsiella spp., Haemophilus influenzae, Escherichia coli, Serratia spp., Streptococcus pneumoniae, and S taphylococcus aureus (methicillin-susceptible strains). 5. Bone and Joint Infections caused by Pseudomonas aeruginosa, Klebsiella spp., Enterobacter spp., and Staphylococcus aureus (methicillin-susceptible strains). 6. Gynecologic Infections, including endometritis, pelvic cellulitis, and other infections of the female genital tract caused by Escherichia coli. 7. Intra-abdominal Infections, including peritonitis caused by Escherichia coli, Klebsiella spp., and Staphylococcus aureus (methicillin-susceptible strains) and polymicrobial infections caused by aerobic and anaerobic organisms and Bacteroides spp. (many strains of Bacteroides fragilis are resistant). 8. Central Nervous System Infections, including meningitis, caused by Haemophilus influenzae and Neisseria meningitidis. Ceftazidime has also been used successfully in a limited number of cases of meningitis due to Pseudomonas aeruginosa and Streptococcus pneumoniae. Tazicef (ceftazidime for injection, USP) may be used alone in cases of confirmed or suspected sepsis. Ceftazidime has been used successfully in clinical trials as empiric therapy in cases where various concomitant therapies with other antibacterial drugs have been used. Tazicef may also be used concomitantly with other antibacterial drugs, such as aminoglycosides, vancomycin, and clindamycin; in severe and life-threatening infections; and in the immunocompromised patient. When such concomitant treatment is appropriate, prescribing information in the labeling for the other antibacterial drugs should be followed. The dose depends on the severity of the infection and the patient's condition. To reduce the development of drug-resistant bacteria and maintain the effectiveness of Tazicef (ceftazidime) and other antibacterial drugs, Tazicef (ceftazidime) should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Clindamycin

Brand Names
ClindaCare, Cleocin, Xaciato, Neuac, Clindacin ETZ, Tretinion, Clindesse, Clindacin, Tretinoin, Clindamycin Phoaphate, Altreno, Benzaclin, Atralin, Twyneo, ZIANA, Tri-Luma, Vesanoid, Retin-A, Clindagel, Acanya, Renova, Onexton

Clindamycin

Brand Names
ClindaCare, Cleocin, Xaciato, Neuac, Clindacin ETZ, Tretinion, Clindesse, Clindacin, Tretinoin, Clindamycin Phoaphate, Altreno, Benzaclin, Atralin, Twyneo, ZIANA, Tri-Luma, Vesanoid, Retin-A, Clindagel, Acanya, Renova, Onexton
Form: Gel, Lotion, Injection, Suppository, Cream, Aerosol, Kit, Granule, Powder, Swab, Capsule, Solution
Method of administration: Oral, Intravenous, Vaginal, Intramuscular, Topical
FDA approval date: May 22, 1970
Classification: Lincosamide Antibacterial
TWYNEO is indicated for the topical treatment of acne vulgaris in adults and pediatric patients 9 years of age and older. TWYNEO is a combination tretinoin, a retinoid, and benzoyl peroxide indicated for the topical treatment of acne vulgaris in adults and pediatric patients 9 years of age and older. ( 1 )

Diflucan

Generic Name
Fluconazole

Diflucan

Generic Name
Fluconazole
Form: Injection, Tablet, Powder
Method of administration: Oral, Intravenous
FDA approval date: December 23, 1993
Classification: Azole Antifungal
Fluconazole Injection, USP is indicated for the treatment of: Oropharyngeal and esophageal candidiasis. In open noncomparative studies of relatively small numbers of patients, fluconazole was also effective for the treatment of Candida urinary tract infections, peritonitis, and systemic Candida infections including candidemia, disseminated candidiasis, and pneumonia. Cryptococcal meningitis. Before prescribing fluconazole for AIDS patients with cryptococcal meningitis, please see CLINICAL STUDIES section. Studies comparing fluconazole to amphotericin B in non-HIV infected patients have not been conducted. Prophylaxis: Fluconazole Injection, USP is also indicated to decrease the incidence of candidiasis in patients undergoing bone marrow transplantation who receive cytotoxic chemotherapy and/or radiation therapy. Specimens for fungal culture and other relevant laboratory studies (serology, histopathology) should be obtained prior to therapy to isolate and identify causative organisms. Therapy may be instituted before the results of the cultures and other laboratory studies are known; however, once these results become available, anti-infective therapy should be adjusted accordingly.

Arikayce

Generic Name
Amikacin

Arikayce

Generic Name
Amikacin
Form: Injection, Suspension
Method of administration: Respiratory (inhalation), Intravenous, Intramuscular
FDA approval date: December 24, 2013
Classification: Aminoglycoside Antibacterial
Amikacin Sulfate Injection USP is indicated in the short-term treatment of serious infections due to susceptible strains of Gram-negative bacteria, including Pseudomonas species, Escherichia coli, species of indole-positive and indole-negative Proteus, Providencia species, Klebsiella-Enterobacter-Serratia species, and Acinetobacter ( Mima-Herellea ) species. Clinical studies have shown Amikacin Sulfate Injection USP to be effective in bacterial septicemia (including neonatal sepsis); in serious infections of the respiratory tract, bones and joints, central nervous system (including meningitis) and skin and soft tissue; intra-abdominal infections (including peritonitis); and in burns and post-operative infections (including post-vascular surgery). Clinical studies have shown amikacin also to be effective in serious complicated and recurrent urinary tract infections due to these organisms. Aminoglycosides, including Amikacin Sulfate Injection USP are not indicated in uncomplicated initial episodes of urinary tract infections unless the causative organisms are not susceptible to antibiotics having less potential toxicity.Bacteriologic studies should be performed to identify causative organisms and their susceptibilities to amikacin. Amikacin may be considered as initial therapy in suspected Gram-negative infections and therapy may be instituted before obtaining the results of susceptibility testing. Clinical trials demonstrated that amikacin was effective in infections caused by gentamicin and/or tobramycin-resistant strains of Gram-negative organisms, particularly Proteus rettgeri, Providencia stuartii, Serratia marcescens, and Pseudomonas aeruginosa. The decision to continue therapy with the drug should be based on results of the susceptibility tests, the severity of the infection, the response of the patient and the important additional considerations contained in the WARNINGS box above. Amikacin has also been shown to be effective in staphylococcal infections and may be considered as initial therapy under certain conditions in the treatment of known or suspected staphylococcal disease such as, severe infections where the causative organism may be either a Gram-negative bacterium or a staphylococcus, infections due to susceptible strains of staphylococci in patients allergic to other antibiotics, and in mixed staphylococci/Gram-negative infections. In certain severe infections such as neonatal sepsis, concomitant therapy with a penicillin-type drug may be indicated because of the possibility of infections due to Gram-positive organisms such as streptococci or pneumococci. To reduce the development of drug-resistant bacteria and maintain the effectiveness of amikacin and other antibacterial drugs, amikacin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Tobramycin

Brand Names
TOBI Podhaler, TOBI, Bethkis, TobraDex, Tobrex

Tobramycin

Brand Names
TOBI Podhaler, TOBI, Bethkis, TobraDex, Tobrex
Form: Injection, Ointment, Inhalant, Suspension, Capsule, Solution
Method of administration: Respiratory (inhalation), Oral, Intravenous, Intramuscular, Ophthalmic
FDA approval date: June 28, 1981
Classification: Corticosteroid
Tobramycin injection is indicated for the treatment of serious bacterial infections caused by susceptible strains of the designated microorganisms in the diseases listed below: Septicemia in the neonate, child, and adult caused by P. aeruginosa, E. coli, and Klebsiella sp Lower respiratory tract infections caused by P. aeruginosa, Klebsiella sp, Enterobacter sp, Serratia sp, E. coli, and S. aureus (penicillinase- and non-penicillinase-producing strains) Serious central-nervous-system infections (meningitis) caused by susceptible organisms Intra-abdominal infections, including peritonitis, caused by E. coli, Klebsiella sp, and Enterobacter sp Skin, bone, and skin structure infections caused by P. aeruginosa, Proteus sp, E. coli, Klebsiella sp, Enterobacter sp and S. aureus Complicated and recurrent urinary tract infections caused by P. aeruginosa, Proteus sp, (indole-positive and indole- negative), E. coli, Klebsiella sp, Enterobacter sp, Serratia sp, S. aureus, Providencia sp, and Citrobacte r sp. Aminoglycosides, including tobramycin, are not indicated in uncomplicated initial episodes of urinary tract infections unless the causative organisms are not susceptible to antibiotics having less potential toxicity. Tobramycin may be considered in serious staphylococcal infections when penicillin or other potentially less toxic drugs are contraindicated and when bacterial susceptibility testing and clinical judgment indicate its use. Bacterial cultures should be obtained prior to and during treatment to isolate and identify etiologic organisms and to test their susceptibility to tobramycin. If susceptibility tests show that the causative organisms are resistant to tobramycin, other appropriate therapy should be instituted. In patients in whom a serious life-threatening gram- negative infection is suspected, including those in whom concurrent therapy with a penicillin or cephalosporin and an aminoglycoside may be indicated, treatment with tobramycin may be initiated before the results of susceptibility studies are obtained. The decision to continue therapy with tobramycin should be based on the results of susceptibility studies, the severity of the infection, and the important additional concepts discussed in the WARNINGS box above. To reduce the development of drug-resistant bacteria and maintain the effectiveness of Tobramycin Injection and other antimicrobial drugs, Tobramycin Injection should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antimicrobial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
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