Peritoneal lavage with doxycycline in acute diffuse peritonitis.

Area of Science:

• Surgical Infections
• Pharmacology
• Microbiology

Background:

• Diffuse peritonitis secondary to perforated appendicitis presents significant treatment challenges.
• Intra-abdominal infections require effective antibiotic strategies targeting polymicrobial flora.

Purpose of the Study:

• To evaluate the efficacy and pharmacokinetic profile of doxycycline administered via peritoneal lavage for diffuse peritonitis.
• To compare doxycycline's antibacterial activity with ampicillin in this clinical setting.

Main Methods:

• Six patients with perforated appendicitis underwent hourly peritoneal lavage with doxycycline (50 mg/L).
• Bacteriological samples were collected from the appendix and peritoneal fluid.
• Doxycycline concentrations in blood and lavage fluid were monitored up to 72 hours postoperatively.

Main Results:

• All patients recovered clinically, though one developed a post-operative abscess and adhesions.
• Bacteriological analysis revealed polymicrobial infections in both appendix and peritoneal fluid.
• Doxycycline demonstrated favorable bacterial sensitivity compared to ampicillin, although the difference was marginal.
• Rapid absorption and slow excretion of doxycycline from the peritoneal cavity led to drug accumulation.

Conclusions:

• Peritoneal lavage with doxycycline is a viable treatment for diffuse peritonitis in perforated appendicitis.
• Doxycycline shows promise as an alternative agent for patients with penicillin allergy or those unresponsive to ampicillin.
• Further studies are warranted to confirm doxycycline's advantages in specific patient populations.