Peritonitis: antibiotic therapy recommendations

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Peritonitis

Possible therapeutic alternatives

Spontaneous bacterial peritonitis (primary).

Duration: 5 - 14 days depending on patient response

Common pathogens

Piperacillin-tazobactam 3.375 grams IV every 6 hours or

Ticarcillin-clavulanic acid 3.1 grams ivpb every 6 hours or

Ampicillin-sulbactam 3 grams IV every 6 hours or

Cefotaxime 2 grams IV every 8 hours or

Ceftriaxone 2 grams ivpb q24h or

Ofloxacin 400mg IV q12h or

Ciprofloxacin 400mg IV q12h or

Levofloxacin 500mg IV qd or

Imipenem 500mg IV every 6 hours

"Secondary" bowel perforation, ruptured appendix etc.

Common pathogens

Single drug therapy:

Ticarcillin-clavulanic acid 3.1 grams IV every 6 hours or

Ampicillin-sulbactam 1.5 to 3 grams IV every 6 hours or

Piperacillin-tazobactam 3.375 grams IV every 6 hours or

Cefotetan 1-2 grams IV q12h or

Cefoxitin 1- 2 grams IV q6h or

Imipenem 500mg IV every 6 hours

Combination therapy:

[Cefotaxime 2 grams every 6 to 8 hours or Ceftriaxone 2 grams IV once daily or Piperacillin 3 to 4 grams IV every 6 hours or Aztreonam 1-2 grams IV every 6 or 8 hours or Ciprofloxacin 400mg IV every 12 hours ]
+ [ Clindamycin 600mg ivpb every 6 to 8 hours or Metronidazole 500mg ivpb every 6 to 8 hours. ]

Penicillin allergic patient:

[Ciprofloxacin 400mg IV every 12 hours + Metronidazole 500mg IV every 6 to 8 hours] or [ Aztreonam + Metronidazole ]

Antimicrobial Series
References

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