Hospitalized Adults: Gastrointestinal Infections: Secondary Peritonitis

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Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines.  Some antimicrobials are restricted (ID-R).  Click on link for guidelines on obtaining authorization.

Diagnosis

Common Pathogens

Drug(s) of First Choice

Alternative Drug(s)

Comments

Secondary Peritonitis

Mild-Moderate intra-abdominal abscess

E. coli

Klebsiella

B. fragilis

Streptococci spp

S. aureus

Ertapenem 1g IV daily

OR

Piperacillin/tazobactamID-R: SFGH 3.375 g IV q6h - 4.5g IV q6h

For severe PCN allergy:

Vancomycin

PLUS

AztreonamID-R: SFGH 2 g IV q8h

PLUS

Metronidazole 500 mg IV q8h

 

Secondary Peritonitis

Severe (major peritoneal soilage, large or multiple abscesses, patient hemodynamically unstable)

E. coli

Klebsiella

B. fragilis

P. aeruginosa

Enterococcus spp.

Streptococcus spp

S. aureus

Vancomycin

PLUS

Piperacillin/tazobactamID-R: SFGH 4.5 g IV q6h

For severe PCN allergy:

Vancomycin

PLUS

Aztreonam ID-R: SFGH 2 g IV q8h

PLUS

Metronidazole 500 mg IV q8h  

ID consultation recommended.

 

For hemodynamically unstable health-care associated infection, consider meropenem.