Intra-abdominal and biliary infection (including systemic infection / sepsis)
Gentamicin IV as per protocol
AND
Amoxicillin 1g IV 8 hourly
AND
Metronidazole 500mg IV 8 hourly
If concerns regarding nephrotoxicity e.g. acute kidney injury - replace Gentamicin with Temocillin IV dosed per Renal Drug Database
Gentamicin IV as per protocol
AND
Vancomycin IV as per protocol
AND
Metronidazole 500mg IV 8 hourly
If concerns regarding nephrotoxicity e.g. acute kidney injury - replace Gentamicin with Aztreonam IV dosed per Renal Drug Database
- Notes
Infected biliary / gastric surgery/ cholecystitis / upper GIT pre - and post-surgery / peritonitis / large bowel sepsis
DO NOT omit Gentamicin from regime unless adding alternative Gram negative bacterial cover.
- Review use of gentamicin at 3 days with microbiology results and clinical response.
- In treatment failure or for rationalisation of therapy then discuss with senior clinician +/- microbiology
Treatment duration: 5-7 days (unless evidence of complicated infection e.g. abscess, collection)Oral switch guidance
Review culture results first. If no positive microbiology to guide:
Preferred regime - Co-amoxiclav 625mg PO 8 hourly
Alternative - Co-trimoxazole 960mg PO 12 hourly AND Metronidazole 400mg 8 hourly