[Antibiotic treatment of peritonitis].

Secondary peritonitis usually results from perforation of a digestive tract organ. The bacterial contamination depends on the site of the perforation (supra or infra mesocolic) and the clinical setting (community or nosocomial). Although bacteriological specimens have not been proven to be diagnostic in community-acquired peritonitis, they are nevertheless mandatory in the nosocomial setting due to the multiresistant nature of the pathogens. Experimental models have evidenced a biphasic course in peritonitis with microbial synergism between aerobic and anaerobic pathogens. These experimental studies have also evidenced the importance of treating enterobacteria and strict anaerobic pathogens. The treatment of community-acquired peritonitis should be targeted against Gram negative bacilli, strict anaerobic germs and enterococci. Resistant Gram negative bacilli and enterococci are the target bacteria for nosocomial peritonitis. Doses should be adapted to renal function and hemodynamic conditions using antibiotics with proven efficacy on susceptibility tests. The theoretical duration of treatment is a question of debate and should be adapted to each individual case.