Advances in the pharmacological management of bacterial peritonitis

ABSTRACT

Introduction: Bacterial peritonitis is an infection with high mortality if not treated immediately. In the absence of an intraabdominal source of infection, bacterial peritonitis may arise in patients with liver cirrhosis, in patients on peritoneal dialysis (PD) for end-stage renal disease or in patients with tuberculosis. In patients with cirrhosis, bacterial peritonitis may trigger acute on chronic liver failure with substantial mortality despite optimal treatment. In patients on PD, peritonitis may make continuation of PD impossible, necessitating the switch to hemodialysis.

Areas covered: Recovery from peritonitis and prevention of complications depend on timely pharmacological management. Challenges are the broad microbiological spectrum with growing rates of antimicrobial resistance, the underlying chronic liver or kidney failure and high rates of relapse. The authors provide a review of predisposing conditions, diagnosis, and prevention of bacterial peritonitis with a particular focus on the pharmacological management.

Expert opinion: Diagnosis of the type of bacterial peritonitis is essential to pharmacological management. In patients with spontaneous bacterial peritonitis, broad-spectrum antibiotics should be given intravenously in conjunction with albumin. In patients on PD, antibiotic therapy should be preferably applied intraperitoneally with empirical coverage of gram-positive and gram-negative bacteria. Secondary peritonitis usually requires surgical or interventional treatment.

KEYWORDS:

• Bacterial peritonitis
• spontaneous bacterial peritonitis
• peritoneal dialysis-related peritonitis
• secondary peritonitis

Article highlights box

• Bacterial peritonitis is an infection with high mortality if not treated quickly.

• Course of peritonitis and prevention of complications depend on timely and adequate pharmacological management and, in case of secondary peritonitis, surgical/interventional source control.

• The broad spectrum of bacteria encountered in peritonitis, the growing rates of antibiotic resistances, the underlying chronic liver and/or kidney failure and high relapse rates constitute a clinical challenge.

• Faster methods for pathogen detection and susceptibility testing might facilitate antimicrobial therapy in the future.

• A better understanding of the immunology of the peritoneal cavity might offer approaches for future pharmacotherapy of bacterial peritonitis.

• Given the growing rates of antibiotic resistances, indication for antibiotic prophylaxis of peritonitis should be strict.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

S von Vietinghoff is supported by Deutsche Forschungsgemeinschaft.