onfirmed Complicated Intra-Abdominal Infections Health Care Associated
(while awaiting pathogen identity and susceptibilities)
Meropenem, imipenem/cilastatin, doripenem, piperacillin/tazobactam, ciprofloxacin4 plus metronidazole, ceftazidime or cefepime plus metronidazole, and aztreonam plus metronidazole plus vancomycin (C-III).
> Empiric antibiotic therapy should be guided by knowledge of the flora seen at the particular hospital and their antimicrobial susceptibilities. In general, this will necessitate use of multi-drug regimens with expanded spectra of activity against Gram negative aerobic and facultative bacilli, which may include aminoglycosides or colistin (B-III).
> Broad spectrum antimicrobial therapy should be tailored when culture and susceptibility reports become available to reduce the number and spectra of administered agents (B-III).
Appropriate Antimicrobial Regimens – Specific Pathogens
Anti-Enterococcal Therapy > Empiric coverage of Enterococcus is not necessary in patients with community-acquired intra-abdominal infections (A-I).
> Initial empiric anti-enterococcal therapy should be directed against
. Antibiotics that can potentially be used against this organism include ampicillin, piperacillin/tazobactam, imipenem/cilastatin, and vancomycin (B-III).
Anti-MRSA Therapy > Vancomycin is recommended for treatment of suspected or proven intra-abdominal infections due to methicillin-resistant Staphylococcus aureus (A-III).
Antifungal Therapy > Empiric antifungal therapy for Candida is not recommended for adults with community-acquired intra-abdominal infections (B-II). > Fluconazole is an appropriate choice if > For fluconazole-resistant
is isolated (B-II). species, therapy with an echinocandin (caspofungin, micafungin, or anidulafungin) is appropriate (B-III).
> For the critically ill patient, initial therapy with an echinocandin instead of a triazole is recommended (B-III).
> Because of toxicity, amphotericin B is not recommended as initial therapy (B-II).
3• The Expert Panel is also concerned that broad use of ertapenem may hasten the appearance of carbapenem- resistant Enterobacteriacae, Pseudomonas, and Acinetobacter species.
4• Quinolone-resistant E. coli has become common in some communities, and quinolones should not be used unless hospital surveys indicate 90% susceptibility of E. coli to quinolone.
5• Given the very broad spectrum of tigecycline, including activity against MRSA and a wide variety of other gram-positive and gram-negative organisms not commonly seen in appendix-derived infection, there is concern for its use in mild-to-moderate complicated intra-abdominal infection.
Recommended empiric regimens
En t
e
ro
c
o
c
c
u
s
C f ae c a l is C an d i da
an
d
i
da
a
l
b
i
can s
