|
Diagnosis |
Common Pathogens |
Drug(s) of First Choice1 |
Alternative Drug(s)1 |
Comments |
INTRA-ABDOMINAL INFECTIONS |
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|
SBP (Spontaneous Bacterial Peritonitis) |
E. coli Klebsiella Strep. spp. |
Ceftriaxone5 1g IV daily
|
For severe PCN allergy3: Vancomycin2 + Aztreonam5 2g IV q8h |
Gram stain recommended
In patients who have received previous courses of antibiotics consider expanding coverage. |
|
Secondary Peritonitis Mild-Moderate intra-abdominal abscess
|
E. coli Klebsiella B. fragilis Strep spp Staph aureus |
Ertapenem 1gm IV daily OR Piperacillin/ Tazobactam6 (Zosyn®) 4.5g q8h |
For severe PCN allergy3: Metronidazole 500 mg IV/PO q8h Plus one of: Aztreonam6 2g IV q8h OR Gentamicin2 All with: Vancomycin |
|
|
Severe (major peritoneal soilage, large or multiple abscesses, patient hemodynamically unstable) or healthcare-associated |
E. coli Klebsiella B. fragilis P. aeruginosa Enterococcus Strep spp Staph aurues |
Vancomycin Plus Piperacillin/ tazobactam6 (Zosyn) 4.5 g IV q6-8h WITH OR WITHOUT* Gentamicin2
|
For severe PCN allergy3: Vancomycin2 Plus one of: Aztreonam6 2g IV q8h OR Gentamicin2 All with: Metronidazole 500 mg IV q8h |
ID consultation is recommended *Consider adding gentamicin for patients with hemodynamic instability or risk of drug-resistant pathogens |