Antibiotics - Abdominal

Infection

Acute infectious diarrhoea

Usually no antibiotic treatment necessary.

Seek advice if treatment required.

Infection

Antibiotic associated diarrhoea

Metronidazole 400mg q8h po. If severe or recurrent or no improvement, consult microbiology.

Metronidazole 400mg q8h po.

If severe or recurrent or no improvement, consult microbiology.

Discontinue current antibiotics if possible, or consult microbiology for advice on choice of agent.

If iv treatment is required only Metronidazole will be effective.

Infection

Intra-abdominal infections - cholangitis / cholecystitis / appendicitis

Mild - moderate:

Co-amoxiclav 1.2g q8h iv.

Severe:

Co-amoxiclav 1.2g q8h iv
plus
Gentamicin 5mg/kg loadig dose.

If hospital acquired:

As above plus please contact micro.

If risk factors for MDRO:

Call micro.

Only if documented history of ESBL:

Meropenem 1g q8h iv (increase to 2g q8h if confirmed)

If faecal peritonitis:

add Metronidazole 400mg q8h po / 500mg q8h iv.

Mild-moderate community acquired:

Ciprofloxacin 400mg q12h iv / 500mg q12h po
plus
Metronidazole 500mg q8h iv / 400mg q8h po.

Severe community acquired or hospital acquired infection:

Ciprofloxacin 400mg q8-12h iv
plus
Gentamicin 5mg/kg q24h iv (max 480mg)
plus
Vancomycin 25mg/kg (max 2g) loading dose then 15mg/kg q12h iv
plus
Metronidazole 500mg q8h iv

If documented Hx ESBL/MDRO:

Check sensitivities. If sensitivities & no recent exposure: As above Ciprofloxacin and Gentamicin. Otherwise seek advice from micro./I.D.

Generally 5-7 days, with regular review.

Switch to oral therapy when improving.

Gentamicin dosing.

If MRSA risk: add either Vancomycin Loading Dose then 15mg/kg q12h iv
or
Teicoplanin 6mg/kg q12h iv for 3 doses then q24h thereafter.

If MUH / SIVUH

Mild - moderate: Co-amoxiclav 1.2g q8h iv.

Severe: Piperacillin-tazobactam 4.5g q8h iv. If severe sepsis or septic shock add Gentamicin 5mg/kg q24h iv (max 500mg q24h).

Infection

Peritonitis-Spontaneous-Bacterial

Prior to commencing antibiotic therapy obtain ascitic fluid for total and differential WCC, culture & sensitivity

Ceftriaxone 2g q24h iv

Vancomycin 25mg/kg (max 2g) loading dose then 15mg/kg q12h iv
plus
Ciprofloxacin 400mg q8-12h iv / 500-750mg q12h po

If quinolone prophylaxis used, seek advice from micro. I.D. for treatment options.

Infection

CAPD peritonitis

Vancomycin 30mg/kg bodyweight (max 3grams) intraperitoneally
plus
Ceftazidime 1.5g intraperitoneally.

Refer to full CAPD peritonitis guidelines for more information

Seek advice in severe penicillin allergy.

See CAPD Peritonitis Guidelines for guidance in taking samples prior to initiation of antibiotics and for follow up doses of antibiotics.

Maintain Vancomycin levels between 15-20mg/L.