Therapeutic options in peritonitis.

The fundamental principles of management of peritonitis include general supportive management, antibiotic therapy, and prompt surgical intervention. Several empiric antibiotic regimens have proven to be effective. All have in common activity against gram-negative bacilli and anaerobic bacteria. The choice of a particular regimen depends primarily on patient-specific factors. Surgical intervention includes source control, peritoneal toilet, and prevention of recurrent infection. Control of the source of contamination involves resecting, excluding, or patching the diseased viscus at laparotomy or, more recently, laparoscopic methods in selected cases. Attempts to prevent recurrent infection using intraoperative saline lavage and radical peritoneal débridement have shown no benefit in well-designed clinical trials. The roles for continuous postoperative peritoneal lavage, planned relaparotomy, and laparostomy in the current management of severe peritonitis remain to be established.