Dose | |
Single-agent regimen | |
Imipenem-cilastatin | 500 mg IV every 6 hours |
Meropenem | 1 g IV every 8 hours |
Doripenem | 500 mg IV every 8 hours |
Piperacillin-tazobactam | 4.5 g IV every 6 hours |
Combination regimen | |
ONE of the following: | |
Cefepime | 2 g IV every 8 hours |
OR | |
Ceftazidime | 2 g IV every 8 hours |
PLUS: | |
Metronidazole | 500 mg IV or orally every 8 hours |
PLUS ONE of the following (in some cases*): | |
Ampicillin | 2 g IV every 4 hours |
OR | |
Vancomycin | 15 to 20 mg/kg IV every 8 to 12 hours |
For empiric therapy of health care-associated intra-abdominal infections, we cover streptococci, enterococci, Enterobacteriaceae that are resistant to third-generation cephalosporins and fluoroquinolones, Pseudomonas aeruginosa, and anaerobes. We include coverage against methicillin-resistant Staphylococcus aureus (MRSA) with vancomycin in those who are known to be colonized, those with prior treatment failure, and those with significant prior antibiotic exposure. Empiric antifungal coverage is appropriate for patients at risk for infection with Candida spp, including those with upper gastrointestinal perforations, recurrent bowel perforations, surgically treated pancreatitis, heavy colonization with Candida spp, and/or yeast identified on Gram stain of samples from infected peritoneal fluid or tissue. Refer to other UpToDate content on treatment of invasive candidiasis.
If the patient is at risk for infection with an extended-spectrum beta-lactamase (ESBL)-producing organism (eg, known colonization or prior infection with an ESBL-producing organism), a carbapenem should be chosen. For patients who are known to be colonized with highly resistant gram-negative bacteria, the addition of an aminoglycoside, polymyxin, or novel beta-lactam combination (ceftolozane-tazobactam or ceftazidime-avibactam) to an empiric regimen may be warranted. In such cases, consultation with an expert in infectious diseases is advised.
When beta-lactams or carbapenems are chosen for patients who are critically ill or are at high risk of infection with drug-resistant pathogens, we favor a prolonged infusion dosing strategy. Refer to other UpToDate content on prolonged infusions of beta-lactam antibiotics.
The combination of vancomycin, aztreonam, and metronidazole is an alternative for those who cannot use other beta-lactams or carbapenems (eg, because of severe reactions).
The antibiotic doses listed are for adult patients with normal kidney function. The duration of antibiotic therapy depends on the specific infection and whether the presumptive source of infection has been controlled; refer to other UpToDate content for details.IV: intravenous.
* We add ampicillin or vancomycin to a cephalosporin-based regimen to provide enterococcal coverage, particularly in those with postoperative infection, prior use of antibiotics that select for Enterococcus, immunocompromising condition, valvular heart disease, or prosthetic intravascular materials. Coverage against vancomycin-resistant enterococci (VRE) is generally not recommended, although it is reasonable in patients who have a history of VRE colonization or in liver transplant recipients who have an infection of hepatobiliary source.Do you want to add Medilib to your home screen?