Peritonitis, bacterial treatment

Mowat C, Stanley AJ Spontaneous bacterial peritonitis - Diagnosis, treatment and prevention. Aliment Pharmacol Ther 2001 15 1851-1859. 

Rimola A, Garcia-Tsao G, Navasa M, et al. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis a consensus document. J Hepatol 2000 32 142-145. 

Fernandez J, Bauer TM, Navasa M, Rodes J Diagnosis, treatment and prevention of spontaneous bacterial peritonitis. Baillieres Best Pract Res Clin Gastroenterol 2000 14 975-990. 

Soares-Weiser K, Paul M, Brezis M, Leibovici M Antibiotic treatment for spontaneous bacterial peritonitis. BMJ 2002 324 100-102. 

C5a is inactivated by the myeloperoxidase-H202 system, which oxidises a methionine residue (Met 70) on the molecule group A streptococcal endo-proteinases also abolish chemotactic activity of C5a and related compounds. Neutrophil lysosomal enzymes (e.g. elastase and cathepsin G) also destroy C5a chemotactic activity, but as these proteases are inhibited by the serum antiproteinases, a -antiproteinase and a2-macroglobulin, the physiological role of neutrophilic proteases in the inactivation of C5a is questionable. Two chemotactic factor inactivators have been found in human serum an a-globulin that specifically and irreversibly inactivates C5-derived chemotactic factors, and a / -globulin that inactivates bacterial chemotactic factors. These activities are heat labile (destroyed by treatment at 56 °C for 30 min) and are distinct from those attributable to anaphylatoxin inactivator. An apparently specific inhibitor of C5-derived chemotactic activity has also been described in human synovial fluid and peritoneal fluid. This factor (molecular mass of 40 kDa) is heat stable and acts directly on C5a. 

Hepato-renal syndrome rapid progressive (type I) with rising serum creatinine levels, or non-progressive and less severe (type II) impairment of renal function, often consequent on bacterial peritonitis, with persistent ascites responds to vasoconstrictor treatment, typically with terlipressin through constriction of splanchnic vessels and improved renal perfusion. Withdrawal of treatment does not seem to lead inevitably to recurrence. Haemodialysis may also stabilise patients. 

Treatment of Bone, respiratory tract, skin and soft-tissue infections, endocarditis, peritonitis, and septicemia prevention of bacterial endocarditis in those at risk (if peniciiiin is contraindicated) when undergoing biliary, dental, GI, GU, or respiratory surgery or invasive procedures IV 500mgq6hor lgql2h. 

Arroyo, V., Navasa, M., Rimola, A. Spontaneous bacterial peritonitis in liver cirrhosis. Treatment and prophylaxis. Infection 1994 22 (Suppl. 31) 167-175... 

Dlnis-Rlbeiro, M., Cortez-Pinto, H., Marlnho, R., Valente, A., Ral-mundo, M., Salgado, M.J., Ramalho, F., Alexandrlno, P., Carnelro-de-Moura, M. Spontaneous bacterial peritonitis in patients with hepatic cirrhosis evaluation of a treatment protocol at specialized units. Rev. Espan. Enferm. Dig. 2002 94 478-481... 

Ascites unresponsive to treatment Hepatopulmonary syndrome Hepatorenal syndrome Recurrent varix bleeding Severe hypoalimentation Spontaneous bacterial peritonitis... 

Trimethoprim is fairly active against a variety of Grampositive cocci and Gram-negative rods. Established indications for co-trimoxazole are infections of the sinuses, ears, lungs, and urinary tract, and infections due to Salmonella, Nocardia, Brucella, Stenotrophomonas maltophilia, Pneumocystis proved, and Toxoplasma (1,6). Co-trimoxazole is also used in the treatment of Wegener s granulomatosis, for prevention of spontaneous bacterial peritonitis, and in patients with advanced HIV infection for the prophylaxis of opportunistic infections (1,6). 

Metronidazole has been shown to be of great value in the management of anaerobic bacterial infections [20,27,75,76]. The role of this drug in the prophylaxis and treatment of various anaerobic bacterial infections, which may develop following appendectomy, elective colonic surgery, colo-rectal surgery and hysterectomy [20,77,78]. Mebendazole is equally useful in cases of endocarditis, osteomyelitis, lung abscess, empyema, peritonitis, septicemia and pelvic infections [79]. 

The following treatment guidelines for the management of adult patients with ascites and spontaneous bacterial peritonitis were developed and approved by the Practice Guidelines Committee of the American Association for the Study of Liver Diseases (AASLD). ... 

TREATMENT RECOMMENDATIONS ASCITES AND SPONTANEOUS BACTERIAL PERITONITIS... 

Guamer C, Runyon BA. Spontaneous bacterial peritonitis Pathogenesis, diagnosis, and treatment. Gastroenterologist 1995 3 311-328. 

Runyon B. Ascites and spontaneous bacterial peritonitis. In Eeldman M, Scharschmidt BE, Sleisenger MH, eds. Sleisenger and Eordtran s Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Treatment, 6th ed. Philadelphia, Saunders, 1998 1310-1333. 

FIGURE 45-5. Pharmacotherapy recommendations for the treatment of bacterial peritonitis in PD patients. 

The usual duration of therapy for peritonitis associated with CAPD is 10 to 14 days, but up to 3 weeks of therapy may be required. Antimicrobial therapy should be continued until dialysate fluid is clear, cultures are negative for 2 to 3 days, and the patient is asymptomatic. When parenteral agents are administered, the initial dose would be the same as that for patients with normal renal function, whereas subsequent doses should be much less or given less frequently for renally excreted agents and should account for possible loss through peritoneal dialysis. Serum concentrations should be performed for aminoglycosides and vancomycin. Some studies have demonstrated that for patients with spontaneous bacterial peritonitis associated with cirrhotic ascites, treatment duration may be as short as 5 days when ascitic fluid polymorphonuclear cell counts are used to guide treatment. 

Runyon BA, McHutchison JG, Antillon MR, et al. Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis. Gastroenterology 1991 100 1737-1742. 

The next step in neutrophil extravasation is inhibited by the Extracellular adherence protein (Eap) of S. aureus. Eap inhibits direct interactions with the host adhesive proteins intercellular adhesion molecule 1 (ICAM-1), fibrinogen or vitronectin, Eap disrupted beta(2)-integrin and urokinase receptor mediated leukocyte adhesion in vitro. In a bacterial peritonitis mouse model, Eap-expressing S. aureus (or isolated Eap) elicited less neutrophil influx as compared to an Eap-negative strain. - Further Eap protects in an ICAM-1 dependent experimental autoimmune encephalomyelitis (EAE) in mice, indicating that Eap could possibly represent a treatment... 

Uses Rifaximin is a non-systemic, gut-selective antibiotic and has been approved in the USA for reducing the risk of recurrence of hepatic encephalopathy in adults. The effects of rifaximin 400-1200 mg/day have been assessed in a retrospective study after treatment with lactulose 20-120 g/day in improving hospitalization outcomes in 65 patients with hepatic encephalopathy [17 ]. Rifaximin reduced the risk, number, and duration of hospitalizations for hepatic encephalopathy compared with lactulose. Fewer patients had evidence of spontaneous bacterial peritonitis while taking rifaximin. Lactulose was associated with many adverse events, including abdominal cramps (n = 2l), bloating ( = 8), pain ( = 19), and excessive diarrhea ( = 54) in contrast, there was only one case of abdominal pain in those who took rifaximin. 

The Ph. Eur. requires solutions for haemodialysis, after dilution, to contain not more than 0.5 lU/mL. Solutions for haemo(dia)filtration and peritoneal dialysis have to be sterile and should not contain more than 0.05 lU/mL bacterial endotoxins according to the present Ph. Eur. requirements (Ph. Eur. 8.0). During a haemo(dia)filtration treatment a large volume of the solution is administered parenterally to the patient (about 60 L per dialysis session). The more stringent requirement for bacterial endotoxins in solutions for haemo(dia)filtration compared to that for solutions for haemodialysis is due to the large volume of solution administered with the first technique. 

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