[Treatment of septic complications od secondary peritonitis]

The authors review the current management goals of surgical and antibiotic therapy in secondary peritonitis. Basic therapeutic regimen is the surgical elimination of the infectious source by means of a rational and risk-adapted operative procedure. Other technical procedures (such as intra- and postoperative lavage, drainage of the abdominal cavity, decompression, etc.) are critically reviewed and reduced to the scientific background. A calculated antibiotic therapy should be performed to eliminate the leading pathogens. The golden standard seems to be the short-term application of a third generation cephalosporin in combination with metronidazole. Antibiotic-induced endotoxinemia, bacterial shifting to grampositive species, and escalating antibiotic resistance require the examination of new therapeutic regimens (e.g. with quinolones).