Intra Abdominal Infection
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Contents |
Etiology
- intestinal perforation
- abdominal surgery
- appendicitis (community-acquired)
- cholangitis, cholecystitis ( healthcare-associated)
- diverticulitis
- infection associates with pancreatitis
- peritonitis
Management
- empiric antibiotics (general)
- moxifloxacin (monotherapy)
- piperacillin tazobactam
- amoxicillin clavulanate
- target gram-negative aerobic & facultative bacilli:
- enterococcal coverage recommended, especially if post-op, prior cephalosporin use, immunocompromised, or patient has valvular heart disease or prosthetic vascular material
- target vancomycin-resistant Enterococcus ( VRE) in very high-risk patients (known colonization, liver transplant with infection of hepatobiliary origin)
- imipenem-cilastatin, meropenem, doripenem, or piperacillin-tazobactam
- metronidazole plus ceftazidime
- metronidazole plus cefepime
- MRSA suspected (known colonization, prior antibiotic failure)
- vancomycin first-line
- quinupristin- dalfopristin, linezolid, daptomycin, & tigecycline have in vitro activity
- guidelines do not recommend specific drug for VRE coverage
- infectious disease consult
More General Terms
References
- Malangoni MA et al, Randomized controlled trial of moxifloxacin compared with piperacillin-tazobactam and amoxicillin-clavulanate for the treatment of complicated intra-abdominal infections. Ann Surg 2006, 244:204 PMID: [1]
- Prescriber's Letter 17(3): 2010 CHART: Antibiotics for Complicated Intra-Abdominal Infections GUIDELINES: Diagnosis and Management of Complicated Intra- abdominal Infections Detail-Document#: [2] (subscription needed) [3]
- National Guideline Clearinghouse
- Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. ngc-guideline: [4]
