Abdominal Infections

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Severe/High Risk or Health Care Associated

Indications

  • Toxic at presentation
  • Severe peritoneal involvement or diffuse peritonitis
  • Delay in initial intervention >24 hours
  • Inability to adequately debride or control infection
Consider for the following populations:
  • Immunocompromising condition
  • Advanced age (>70 years)
  • Hospitalization for ≥ 5 days in the last 3 months
  • Antibiotic use for ≥ 2 days in the last 30 days
  • Abdominal procedure in the last 3 months
  • Extreme poor nutritional status

First line treatment

  • Piperacillin/Tazobactam 3.375 g IV every 6 hours**

Note: The addition of Vancomycin is not indicated without an appropriate indication. See Indications to Add MRSA Coverage for intra-abdominal infection. 

Penicillin alternative

  • Aztreonam 1g IV every 8 hours plus Metronidazole 400mg IV every 8 hours plus Vancomycin 15 mg/kg IV every 12 hours***

Duration*

  • 4 days after source control

Notes

*Longer treatment regimens may be needed if:

  • Lack of source control
  • Immunosuppressed patients

**Consider the following in critically ill patients:

  • IDSA guidelines recommend against fluoroquinolone use in setting of severe/high risk infection if resistance patterns of E. coli are <10-20%
  • Institution specific (UMC) sensitivity is 65%
  • A Fluoroquinolone is a reasonable choice in mild to moderate community acquired intra-abdominal infection based on sensitivities.

***For any toxic patient, consider a Vancomycin loading dose of 25 mg/kg followed by 15 mg/kg every 12 hours. Every Vancomycin order requires pharmacokinetic consult.

 

Disclaimer: The contents of this application are for the exclusive and specific use of University of Mississippi Medical Center faculty and trainees. Any other use is neither authorized nor sanctioned by UMMC. The information is for educational purposes only. The contents of this application are for the exclusive and specific use of UMMC faculty and trainees. Any other use is neither authorized nor sanctioned by UMMC. The information is for educational purposes only.