Healthcare-associated secondary peritonitis: Mild-Moderate intra-abdominal abscess

Diagnosis Common Pathogens Drug(s) of First Choice Alternative Drug(s) Comments Expected Duration

Healthcare-associated secondary peritonitis

Mild-Moderate intra-abdominal abscess

E. coli

Klebsiella

B. fragilis

Streptococci spp

S. aureus

Enterococcus

Ertapenem

OR 

Piperacillin/tazobactam

For severe PCN allergy:

Vancomycin PLUS

Aztreonam PLUS

Metronidazole
Fungal coverage rarely needed empirically but consider in high-risk patients: critically ill with upper GI source, recurrent bowel perforation, heavy colonization, surgically-treated pancreatitis

Stop antibiotics 4 days after source control achieved

 

If source control is not obtained, consultation with ID recommended

Clinical Infectious Diseases, Volume 50, Issue 2, 15 January 2010, Pages 133–164, https://doi.org/10.1086/649554