STAGE-RELATED ANTIBIOTIC-TREATMENT OF SUR GICAL PERITONITIS - A PROSPECTIVE PROTOCOL

Patients and methods: In a prospective protocol 25 consecutive patient s with diffuse peritonitis were treated in the Surgical Clinic of the RWT-University in Aachen, Germany, from January to December 1995. Acco rding to the ''Mannheim Peritonitis Score'' three different stages wer e treated with different surgical procedures and a selective antibioti c regimen. Group-A patients with prognostically favorable peritonitis (MPS 0-20) were treated with the so-called standard procedure. group-B patients (MPS: 21-29) with closed postoperative lavage. The antibioti c regimen was cefotaxime (2 x 2 g) and metronidazole (2 x 500 mg) for both group-A and group-B patients. Severe group-C cases (MPS >29) were treated with the so-called Etappenlavage (multiple reexplorations and intraoperative lavage) and received a combination of three antibiotic s (2 x 2 g cefotaxime; 2 x 500 mg metronidazole and 2 x 200 mg ofloxac in). Results: Eight patients belonged to group A, 10 to group B, and 7 to group C. The mortality was 0% (group A), 20% (group B). and 29% (g roup C), respectively. The actual overall mortality of the whole group was 16% (4/25). The statistically expected mortality was 36%, accordi ng to the APACHE-II-Score (P = 0.0982).