Washing with or without chloramphenicol in the treatment of peritonitis: a prospective, clinical trial

One hundred one suitable patients with peritonitis of diverse origin were randomized into two groups. In each patient in group 1 (50 patients), the abdomen was washed after the appropriate surgical procedure with normal saline solution, and 2 gm chloramphenicol was introduced before abdominal closure; in each patient in group 2 (51 patients), the abdomen was washed as in group 1, but chloramphenicol was not instilled. All patients were given 1 gm chloramphenicol intramuscularly either preoperatively or intraoperatively and 3 gm daily for 3 days. Chloramphenicol was selected on the basis of its activity against aerobic and anaerobic bacteria and its demonstrated stimulating effect on peritoneal macrophages in vitro. All explorations were done through the midline, and the skin and subcutaneous tissues were closed secondarily 3 to 4 days after operation. No drains were used. The two groups were roughly comparable, but results were significantly better for all parameters studied in patients receiving chloramphenicol locally. Blood dyscrasias were not observed. It is suggested that the combination of washing and local antibiotics is superior to washing alone; in addition to its parenteral administration, chloramphenicol is of considerable value if instilled in the area of peritonitis after washing; and besides its bacteriostatic action, chloramphenicol may have a local stimulating effect on peritoneal defenses and may therefore be the drug of choice for local use in generalized peritonitis.