Peritonitis

Background

Inflammation of serosal membrane lining abdominal cavity and intraabdominal organ
May be infectious (bacterial, viral, fungal) or sterile (mechanical, chemical)
Etiology
- Primary: Hematogenous, spontaneous bacterial peritonitis (SBP)
- Secondary: Perforation or trauma, most common
- Tertiary: Persistent/recurrent infection, peritoneal dialysis-associated peritonitis

Imaging = CT Abd/pelvis (preferred) or 3-view abdomen XR
- Ultrasound may reveal certain etiologies
Other work-up based on clinical suspicion, and may include:
- CBC, metabolic panel, coags, lipase, UA, stool studies
- Diagnostic paracentesis to evaluate for SBP (PMN ≥ 250 cells/mm³)

	Harbor-UCLA	Santa Monica-UCLA	Other
Primary	Metronidazole 500mg IV q8hrs Plus one of the following: Ceftriaxone 1g IV once daily Ciprofloxacin 400mg IV q12hrs Cefazolin 1g (30mg/kg) IV q8hrs Levofloxacin 750mg IV once daily	Metronidazole 500mg IV q8h + Vancomycin 15mg/kg/dose IV q12h (Max dose = 1500mg) Plus one of the following: Piperacillin/tazobactam 4.5g IV q6h Ertapenem 1g IV q24h Ceftriaxone 1g IV q24h	One of the following: Piperacillin-tazobactam Ticarcillin-clavulanate 3.1 g IV every 6 hours Ertapenem 1 g every 24 hours Moxifloxacin 400 mg IV every 24 hours
Allergy or prior exposure	Piperacillin/Tazobactam 4.5g (80mg/kg) IV q8hrs OR Metronidazole 500mg IV q8hrs PLUS Cefepime 2g IV once daily OR Ciprofloxacin 400mg IV q12hrs OR Levofloxacin 750mg IV once daily Meropenem 1g (20mg/kg) IV q8hrs OR Doripenem 500mg IV q8hrs OR Aztreonam 2g (30mg/kg) IV q8hrs + Metronidazole 500mg IV q8hrs	aztreonam 2g IV q8h + metronidazole 500mg IV q8h +/- vancomycin 15mg/kg/dose IV q12h (Max dose = 1500mg)

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