Tatalaksana & Edukasi

PeritonitiS et causa Perforasi

appendiks 22
Kasus Emergency
Resusitasi Cairan Optional
Puasa Nutrisi Parenteral
Dekompresi & evakuasi Injeksi analgetik ( tegak diagnosis )
Injeksi Antibiotika
Rujuk ke Spesialis ( Surgikal )
 Monotherapy

Beta lactam/ Beta lactamase inhibitor

Piperacilli/ Tazobactam
Ticarcillin/ clavulanicacid

Carbapenem
Ertapenem
Imipenem/ Cilastatin
Meropenem
 Combination therapy

Cephalosporin- based
Cefuroxime + metronidazole
3- 4 generation cephalosporin + Metronidazole

Quinolone based
Ciprofloxacin + Metronidazole

Aminoglycoside based
Aminoglycoside + Clindamycin
Astreonam + metronidazole
Microbiology of Peritonitis Treatment
Peritonitis Etiology Therapy
Group Species
E. Coli
K. Pneumonia
Pseudomonas sp Third Generation
Primary Peritonitis Gram- negative Proteus sp Cephalosporin
Streptococcus sp
Stapylococcus sp
Anaerobic sp.(
Bacteroides sp )
Perforated Appendicitis Secondary

Peritonitis Etiology Therapy

Group Species
E. Coli
Enterobacter sp
Gram negative
Klebsiella sp 2 generation cephalosporin

Proteus sp 3 generation cephalosporin

Gram positive Streptococcus sp Penicillin

Secondary Peritonitis
Enterococcus sp Quinolone
Anaerobic Bacteroides fragilis Quinolone + metronidazole

Other Bacteroides sp Aminoglycoside +

metronidazole
Eubacterium sp
Clostridium sp
Anaerobic Streptococcus sp
Edukasi
Harus dilakukan operasi apendektomi secepatnya

Risiko tidak dioperasi :

sepsis inflammatory response syndrome
septic hypotension
Septic shock
Multiple organ damage syndrome
Kematian

Risiko dioperasi:
perdarahan, infeksi, adhesi