Cefamandole-erythromycin-heparin peritoneal irrigation: an adjunct to the surgical treatment of diffuse bacterial peritonitis.

The enthusiasm for the use of peritoneal irrigation has waxed and waned since its introduction by Dr. Pierce in 1905. The purpose of this study was to devise a relatively low-cost irrigant that could be used for continuous intraperitoneal lavage, with the intent of decreasing abscess formation following surgical treatment for generalized bacterial peritonitis. A solution of 1 L of normal saline containing 50 mg erythromycin, 50 mg cefamandole, 500 U heparin, and 5 mEq KCl was proven in in vitro studies to be bactericidal to Peptococcus anaerobius and Clostridium perfringens, and bacteriostatic to Klebsiella pneumoniae, Escherichia coli, Enterobacter aerogenes, Streptococcus faecalis, and Bacteroides fragilis. In a prospective study 50 patients underwent peritoneal lavage with 36 L over 2 days. No lavage patients developed intraabdominal abscesses. In a control group of 44 patients seven patients (15.9%) developed postoperative abscesses.