Pediatric Guidelines: Intra-Abdominal Infections - Necrotizing Enterocolitis

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Condition Major Pathogens First Choice Therapy Alternative Therapy Comments
Necrotizing enterocolitis, definite

Enteric Gram negatives

Anaerobes

Ampicillin

AND

Gentamicin

AND if perforation, critical illness, or worsening on Ampicillin and Gentamicin, ADD Metronidazole

Piperacillin-tazobactam (Zosyn) may be used in the setting of impaired renal function or persistent hypotension

Refer to Neonatal Dosing Guideline for antibiotic doses and intervals

Click here for further guidelines on antibiotic selection and duration of therapy for necrotizing enterocolitis

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).