Peritonitis is a life-threatening condition, which requires medical treatment as soon as

possible. The main principle of therapy in intra-abdominal infections is:

1. Control the source of infection

2. Eliminate bacteria and toxins

3. Maintain the functioning of the organ system

4. Control the inflammatory process

Therapy is divided into:

 Medical therapy, including systemic antibiotics to control infections, intensive

care maintains body hemodynamics for example administration of intravenous
fluids to prevent dehydration, nutrition control and metabolic conditions, treatment
of complications from peritonitis (for example respiratory or renal insufficiency),
and treatment of inflammation that occurs.
 Nonoperative interventions, including percutaneous abscess drainage and
percutaneous and endoscopic stent placement.
 Operative therapy, surgery is often needed to overcome the source of infection, for
example appendicitis, ruptured intra-abdominal organs

If all the therapeutic steps above have been implemented, administration

supplements, including glutamine, arginine, omega-3 and omega-6 fatty acids,
vitamins A, E and C, Zinc can be used as an adjunct to accelerate healing process.
ANTIBIOTIC THERAPY

In SBP (Spontaneus Bacterial Peritonitis), the administration of antibiotics is

mainly is cephalosporin gen-3, then given antibiotics according to the results culture.
The use of aminolikosida should be avoided especially in patients with chronic kidney
disorders because of its nephrotoxic effects. Duration of administration therapy is
usually 5-10 days.

In secondary and tertiary peritonitis, systemic antibiotic therapy is present

second. For prolonged infection, systemic antibiotics are not effective again, but more
useful in acute infections.

In severe intra-abdominal infections, imipenem administration, piperacillin /

tazobactam and the combination of metronidazole with aminoglycosides.

NON-OPERATIVE INTERVENTION

Percutaneous drainage of abdominal and extraperitoneal abscesses can be

performed. The effectiveness of this technique can delay surgery until the acute
process and sepsis has been resolved, so that surgery can be done electively. Things
that the reasons for the non-operative intervention's failure are the fistula enteris,
pancreatic involvement, multiple abscesses. This non-operative intervention therapy
is generally successful in patients with peritoneal abscess caused by intestinal
perforation (for example appendicitis, diverticulitis).

This technique is an additional therapy. If an abscess can be accessed through

percutaneous drainage and no pathological disorders of organs Other intra-abdominal
procedures that require surgery, then this percutaneous drainage can be used safely
and effectively as a primary therapy. Complications are can occur including bleeding,
sores and erosion, fistulas.
OPERATIVE THERAPY

This method is the most effective. Surgery is done in two ways, first, open
surgery, and second, laparoscopy.