Initial Empiric Treatment of Extra-biliary Complicated Intra-abdominal Infection Infection

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Initial Empiric Treatment of Extra-biliary Complicated Intra-abdominal Infection Infection
Definition Signs/ Symptoms Management
Antibiotic Comment
Community-acquired infection with Mild-to-moderate severity: Acute diverticulitis and perforated or abscessed appendicitis. Rapid-onset abdominal pain and symptoms of gastrointestinal
Single agents or Combination Therapy

Single agents: Select one of the following antibiotics

  • Ertapenem 1 g IV every 24 hours
  • Moxifloxacin 400 mg IV every 24 hours

OR

Combination: Select one of the following antibiotics

  • Ceftriaxone 1–2 g IV every 24 hours
  • Cefotaxime 1–2 g IV every 6–8 hours
  • Levofloxacin 750 mg IV every 24 hours
  • Ciprofloxacin 400 mg IV every 12 hours

PLUS

  • Metronidazole 500 mg IV every 8–12 hours
Community-acquired infection with High risk or severity: severe physiologic disturbance, advanced age, or immunocompromised state
Broad-spectrum coverage (including Pseudomonas)

Single agent: Select one of the following antibiotics

  • Piperacillin-tazobactam 4.5 g IV every 6 hours
  • Imipenem-cilastatin 500 mg IV every 6 hours or 1 g every 8 hours
  • Meropenem 1 g IV every 8 hours

OR

Combination: Select one of the following antibiotics

  • Cefepime 2 g IV every 8–12 hours
  • Ceftazidime 2 g IV every 8 hours
  • Levofloxacin 750 mg IV every 24 hours
  • Ciprofloxacin 400 mg IV every 12 hours

PLUS

  • Metronidazole 500 mg IV every 8–12 hours
 Empirical Anti-MRSA or yeast is not recommended in the absence of evidence of infection due to such organisms
Health Care–Associated Complicated Intra-abdominal Infection:
< 20% Resistant Pseudomonas aeruginosa, ESBL-producing Enterobacteriaceae, Acinetobacter, or other MDR pathogen.

Single agent: Select one of the following antibiotics

  • Piperacillin-tazobactam 4.5 g IV every 6 hours
  • Imipenem-cilastatin 500 mg IV every 6 hours or 1 g every 8 hours
  • Meropenem 1 g IV every 8 hours

OR

Combination: Select one of the following antibiotics

  • Cefepime 2 g IV every 8–12 hours
  • Ceftazidime 2 g IV every 8 hours

PLUS

  • Metronidazole 500 mg IV every 8–12 hours
P. aeruginosa > 20% resistant to ceftazidime or ESBL-producing Enterobacteriaceae

Single agent: Select one of the following antibiotics

  • Piperacillin-tazobactam 4.5 g IV every 6 hours
  • Imipenem-cilastatin 500 mg IV every 6 hours or 1 g every 8 hours
  • Meropenem 1 g IV every 8 hours
 Empirical Anti- MRSA should be provided to patients who are known to be colonized with MRSA or who are at risk of having an infection due to MRSA because of prior treatment failure and significant antibiotic exposure.
Duration: 4–7 days, unless it is difficult to achieve adequate source control.
References:

Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America