Massive Doses of Penicillin in the Treatment of Peritonitis*
The purpose of this report is to call attention to the fact that large doses of penicillin (100,000 units or more intramuscularly every two hours) exert a striking effect in controlling peritonitis arising from mixed flora of the intestinal tract. Penicillin, first in large doses and then in diminishing amounts for a week or ten days, will profoundly inhibit dissemination of peritonitis and will result in spontaneous resolution of many intraperitoneal abscesses. Large initial doses of penicillin and protracted therapy produce results far superior to those observed with the usual doses or the sulfonamides.
Early reports on the use of penicillin in peritonitis were equivocal and gave little promise that this drug would be superior to the sulfonamides.1 At that time penicillin was scarce and expensive, and the average dose was not more than 30,000 units intramuscularly every three or four hours. Penicillin in these doses exerted a striking effect in controlling peritonitis from hemolytic streptococcal or staphylococcal infections, but appeared to do little to control mixed infections from perforated appendixes. Although peritonitis seemed less likely to spread and the patients were less sick, penicillin exhibited little advantage over the sulfonamides. Formation of intraabdominal abscesses was not prevented, and a prolonged febrile course with eventual suppurative complications was the rule.
During the past four months 30 patients with established peritonitis or with extensive contamination of the peritoneal cavity from rupture of intraabdominal abscesses were treated at the U. S. Naval Hospital, San Diego. There were 2 cases of spontaneous perforation. . .