Peritonitis prevention

Drug therapy for portal hypertension and cirrhosis can alleviate symptoms and prevent complications but it cannot reverse cirrhosis. Drug therapy is available to treat the complications of ascites, varices, spontaneous bacterial peritonitis, hepatic encephalopathy, and coagulation abnormalities. 

Treatment Exit-site infections may be treated immediately with empiric coverage, or treatment may be delayed until cultures return. Empiric treatment of catheter-related infections should cover S. aureus. Coverage for P. aeruginosa should also be included if the patient has a history of infections with this organism.49 Cultures and sensitivity testing are particularly important in tailoring antibiotic therapy for catheter-related infections to ensure eradication of the organism and prevent recurrence or related peritonitis. 

Prevention of peritonitis and catheter-related infections starts when the catheter is placed. The exit site should be properly cared for until it is well healed before it can be used for PD. Patients should receive proper instructions for care of the catheter during this time period, which can last up to 2 weeks. Patients should also be instructed on the proper techniques to use for dialysate exchanges to minimize the risk of infections during exchanges, which is the most common cause of peritonitis. 

Intranasal S. aureus increases the risk of S. aureus exit-site infections, tunnel infections, peritonitis, and subsequent catheter loss.49 Several measures have been used to decrease the risk of peritonitis caused by S. aureus, including mupirocin cream applied daily around the exit site, intranasal mupirocin cream twice daily for 5 days each month, or rifampin 300 mg orally twice daily for 5 days, repeated every 3 months.49 Mupirocin use is preferred over rifampin to prevent the development of resistance to rifampin, although mupirocin resistance has also been reported.49 Other measures that have been used to decrease both S. aureus and P. aeruginosa infections include gentamicin cream applied twice daily and ciprofloxacin otic solution applied daily to the exit site.49... 

Primary peritonitis is treated with antimicrobials and rarely requires drainage. Secondary peritonitis requires surgical removal of the inflamed or gangrenous tissue to prevent further bacterial contamination. If the surgical procedure is sub-optimal, attempts are made to provide drainage of the infected or gangrenous structures. 

Furthermore, pH determination has been used in other clinical research, both alone and in combination with other measurements. This research includes studies into the relationship between extracellular and intracellular pH in an ischemic heart [6, 7], the pH of airway lining fluid in respiratory disease [8], the study of pH as a marker for pyloric stenosis [9], malnutrition in alkalotic peritoneal dialysis patients [10], pH modulation of heterosexual HIV transmission [11, 12], and wound prevention and treatment [13], In addition, pH changes due to blood acidosis have been used to trigger and pace the ventricular rate of an implanted cardiac pacemaker [14], Research using pH measurements... 

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

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. 

Trespi E, Colla C, Belloni G, Pollino MG, Magnani L, Panizza P, Venturini A Efficacy of rifaximin as a prophylactic agent for the prevention of spontaneous bacterial peritonitis in alcoholic patients. Ital J Gastroenterol Hepatol 1999 31 534A. 

In humans, the intradermal injection of SP (10 7-10 5 M) produces a flare, wheal and itching, and these effects are prevented by pretreatment with chlorcyclizine (an antihistamine) or by local pretreatment with compound 48/80 [ 103, 104]. It causes histamine release from sections of human foreskin [105]. These authors suggested that SP is significantly less active on isolated rat peritoneal mast cells than in human skin. 

Bk has been shown to stimulate histamine release from isolated peritoneal rat mast cells [30, 87] and this secretory response, like that elicited by other peptides, requires a source of metabolic energy and is prevented by depletion of cellular Ca [30, 87]. The subsequent treatment of such cellular Ca-depleted mast cells with Bk produces an inactivation or desensitization phenomenon to the subsequent addition of extracellular Ca (secretion declines as the time... 

The two important fuels for colonocytes are glutamine and short-chain fatty acids. The oxidation of both fuels provides ATP for the cells, which is important not only to maintain digestive and absorptive functions but also to maintain membrane structure and hence the physical barrier between the lumen and the blood and peritoneal cavity. This barrier normally prevents significant rates of translocation of bacteria into the peritoneal cavity and thence into the blood. If this barrier is breached, translocation of pathogens and... 

It is usually considered that pathogens that cause problems in the intestine have entered via the mouth, but more than one million pathogens are present in the large intestine. These can enter the bloodstream when the intestinal barriers are not sufficient to prevent translocation (Chapter 18). Conditions that increase translocation and can, therefore, lead to peritoneal sepsis are as follows. 

Peritonitis infection of ascitic fluid, characteristically by gram negative organisms without an obvious cause, is common in patients with increasing ascites, and is diagnosed by raised ascitic polymorphonuclear cell counts. Treatment with third generation cephalosporins, or amoxicillin and clavulanic acid is effective. Concurrent albumin supplementation helps prevent renal failure. 

Gonadotropins are used to treat infertility in women with potentially functional ovaries who have not responded to other treatments. The therapy is designed to simulate the normal menstrual cycle as far as is practical. A common protocol is daily injections of menotropins for 9 to 12 days, until estradiol levels are equal to that in a normal woman, followed by a single dose of hCG to induce ovulation. Two problems with this treatment are risks of ovarian hyperstimulation and of multiple births. Ovarian hyperstimulation is characterized by sudden ovarian enlargement associated with an increase in vascular permeability and rapid accumulation of fluid in peritoneal, pleural, and pericardial cavities. To prevent such occurrences, ovarian development is monitored during treatment by ultrasound techniques and by measurements of serum levels of estradiol. 

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. 

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