[Chemotherapy of peritonitis with particular reference to concentrations of sulbenicillin in human ascites (author's transl)].

Twenty-seven patients with peritonitis to whom a drain was applied were given sulbenicillin (SBPC), a broad-spectrum antibiotic, which has so little hepatic and renal toxicity that massive doses may be feasible, and examination was made as to its therapeutic effects and concentrations of the antibiotic in the ascites. Daily dosage of SBPC was 10g in two divided doses in most cases given by the intravenous infusion. Medication was continued for 3 approximately 15 days. The highest daily dosage was 20g and the largest total dosage reached 190g, but there was no adverse reaction except for one case of a slight anemia. Peritonitis complicated appendicitis, adnexitis, duodenal ulcer perforation, intestinal obstruction or trauma as its primary disease. No difference in the therapeutic effect existed among the primary diseases. The response to SBPC treatment was excellent in 8 of the 27 patients and good in 17. Two patients failed to respond to the therapy. When SBPC was given just before operation, the SBPC concentration in ascites obtained at operation was 112 microgram/ml in 2 cases. The SBPC concentrations in ascites were examined following intravenous infusion of 5g over an hour, and a peak concentration of 94.7 microgram/ml was obtained at the completion of infusion (an hour after the start of infusion), which gradually decreased thereafter. In the ascites excreted from the drain after operation, a high concentration of 12.7 approximately 90.2 microgram/ml (mean: 51.7 +/- 7.7 microgram/ml) was obtained on the day after the operation day, but the concentration was lower thereafter. The SBPC concentrations in ascites were compared as regards the sites of drainage (Winslow's foramen, ileocecum and Douglas' fold), but no particular difference was observed. The SBPC concentrations in ascites after operation were in inverse proportion to the alleviation of peritonitis. They were higher when the inflammation was severer.