| Diagnosis | Common Pathogens | Drug(s) of First Choice | Alternative Drug(s) | Comments | Expected Duration |
|---|---|---|---|---|---|
|
Community-acquired secondary peritonitis Mild-moderate intra-abdominal abscess (community acquired) |
E. coli Klebsiella B. fragilis Streptococci spp |
Ceftriaxone PLUS |
For severe beta-lactam allergy: Vancomycin PLUS Aztreonam PLUS |
Stop antibiotics 4 days after source control achieved If source control is not obtained, consultation with ID recommended |
|
|
Healthcare-associated secondary peritonitis Mild-Moderate intra-abdominal abscess (including post-op pelvic abscesses) |
Community pathogens PLUS S. aureus Enterococci P. aeruginosa |
OR Cefepime PLUS |
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 |
|
Severe peritonitis with major peritoneal soilage, large or multiple abscesses, or hemodynamically unstable |
Similar to healthcare associated peritonitis |
PLUS one of OR Meropenem* |
For severe PCN allergy: Vancomycin PLUS Aztreonam PLUS Metronidazole |
*For hemodynamically unstable health-care associated infection, consider meropenem 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 |
ID consultation is recommended |
|
Diverticulitis For severe infection, refer to severe secondary peritonitis, above |
E. coli Klebsiella B. fragilis Streptococci spp |
Management without antibiotics can be considered in patients with uncomplicated disease (no signs of severe infection, no evidence of fistula or abscess, not immunosuppressed) Inpatient: Ceftriaxone PLUS Outpatient: Amoxicillin/clavulanic acid 875/125 mg po TID OR Ciprofloxacin PLUS |
For severe beta-lactam allergy: Inpatient: Vancomycin PLUS Aztreonam PLUS Outpatient: Ciprofloxacin PLUS |
10 days (can step down to oral therapy to complete course) | |
| SBP (Spontaneous Bacterial Peritonitis) |
E. coli Klebsiella spp. Streptococci. spp. |
Ceftriaxone |
Vancomycin PLUS |
In patients who received previous courses of antibiotics consider expanding coverage If known MDR GNR and/or VRE colonization/infection within 90 days, expand coverage to include these pathogens |
5 days |
| Liver abscess |
E. Coli Klebsiella Strep milleri group (S. anginosus, constellatus, intermedius) |
Ceftriaxone PLUS |
For severe beta-lactam allergy: Vancomycin PLUS Aztreonam PLUS |
Consider Vancomycin if patient is hemodynamically unstable Consider amoebic liver abscess if appropriate travel history |
ID consult recommended |
Clinical Infectious Diseases, Volume 50, Issue 2, 15 January 2010, Pages 133–164, https://doi.org/10.1086/649554