Intra-Abdominal Sepsis including Bacterial Peritonitis and Hepatobiliary Sepsis

Duration

Cholecystitis/cholangitis: duration usually 7 days depending on response

Post-operative treatment of intrabdominal sepsis: duration 5 days once adequate source control obtained.

1st line

Important: Therapy

Amoxicillin IV 1g 8 hourly

+

Metronidazole IV 500mg 8 hourly

+

Gentamicin (Extended Interval Dosing as per guideline. Use gentamicin calculator)

 

IV to oral switch

Select IVOS according to culture results. If no culture results to guide therapy use empirical choice below.

(doses assuming normal renal function)

Co-trimoxazole oral 960mg 12 hourly

+

Metronidazole oral 400mg 8 hourly

Penicillin or Cephalosporin allergy

Important: Therapy

Vancomycin IV (dosing as per guideline. Use vancomycin calculator)

+

Ciprofloxacin oral 500mg 12 hourly (or IV 400mg 12 hourly if oral route not suitable)

+

Metronidazole IV 500mg 8 hourly

and discuss with Consultant Microbiologist.

 

IV to oral switch

Select IVOS according to culture results. If no culture results to guide therapy use empirical choice below.

(doses assuming normal renal function)

Co-trimoxazole oral 960mg 12 hourly

+

Metronidazole oral 400mg 8 hourly