Pediatric Guidelines: Intra-Abdominal Infections - Healthcare-Associated

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Condition Major Pathogens First Choice Therapy Alternative Therapy Comments
Intra-abdominal infection, healthcare-associated

Enteric Gram negatives

Pseudomonas aeruginosa, other resistant Gram negatives

Piperacillin-tazobactam (Zosyn) 100mg/kg/dose piperacillin q6h (max 4g piperacillin/dose)

Non-severe penicillin allergy:

Cefepime 50mg/kg/dose IV q8h (max 2g/dose)

AND 

Metronidazole 10mg/kg/dose IV q8h (max 500mg/dose)

Consider ID consult especially if additional patient risk factors, immunocompromised patient or severe infection

Duration: If adequate source control, treat until resolution of abdominal signs & symptoms, usually <= 7 days

Severe beta lactam allergy:

Ciprofloxacin 15     mg/kg/dose IV q12h (max 400mg/dose) 

AND 

Metronidazole 10mg/kg/dose IV q8h (max 500mg/dose)

Reference: Solomkin, JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of AmericaClin Infect Dis 2010;50:133-164. 

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).