Appropriate Antimicrobial Regimen
Antimicrobial Resistance & Toxicity ÎMild-to-moderate severity community-acquired infections:
> Ampicillin/sulbactam is not recommended because of high resistance of Escherichia coli to this agent (B-II).
> Cefotetan and clindamycin are not recommended for use because of increasing resistance of the Bacteroides fragilis group to these agents (B-II).
ÎHealth care-associated infections:
> Routine use of combination or dual therapy for Gram negative facultative and aerobic bacilli is not recommended in the absence of evidence that the patient is likely to harbor resistant organisms requiring such therapy (A-I).
Table 2A. Agents and Regimens that may be Used for Treatment of Biliary Infections
Community-acquired acute cholecystitis of mild-to-moderate severity
> Cefazolin > Cefuroxime > Ceftriaxone
Community-acquired acute cholecystitis of severe physiologic disturbance, advanced age, or immunocompromised state
> Imipenem/cilastatin > Meropenem > Doripenem > Piperacillin/tazobactam > Ciprofloxacin, levofloxacin, or cefepime, each in combination with metronidazole
Acute cholangitis following bilio-enteric anastomosis of any severity
> Imipenem/cilastatin > Meropenem > Doripenem > Piperacillin/tazobactam > Ciprofloxacin, levofloxacin, or cefepime, each in combination with metronidazole
Health care-associated biliary infection of any severity
> Imipenem/cilastatin > Meropenem > Doripenem > Piperacillin/tazobactam > Ciprofloxacin, levofloxacin, or cefepime, each in combination with metronidazole > Vancomycin added to each regimen
> Because of the availability of less toxic agents demonstrated to be of at least equal efficacy, aminoglycosides are not recommended for routine use in community- acquired intra-abdominal infection in adults (B-II).
