Antimicrobial regimens for patients with complicated intra-abdominal infections. WSES/Global Alliance for Infections in Surgery suggestions.

Empiric antibiotic regimens for non-critically ill patients with community-acquired IAIs. Normal renal function

Community-acquired cIAIs

Non-critically ill patients

Amoxicillin/clavulanate 1.2-2.2 g 8-hourly

or

Ceftriazone 2 g 24-hourly + Metronidazole 500 mg 6-hourly

or

Cefotaxime 2g 8-hourly + Metronidazole 500 mg 6-hourly

or

In patients with beta-lactam allergy

Ciprofloxacin 400 mg 12-hourly + Metronidazole 500 mg 6- hourly

or

Moxifloxacin 400 24-hourly

or

In patients at high risk for infection with community-acquired ESBL-producing Enterobacteriacea

Ertapenem 1 g 24 hourly

or

Tigecycline 100 mg initial dose, then 50 mg 12-hourly

Empiric antibiotic regimens for critically ill  patients with community-acquired IAIs. Normal renal function

Community-acquired IAIs

Critically ill patients

Piperacillin/Tazobactam 4.5 g 6-hourly

or

In patients at high risk for infection with community-acquired ESBL-producing Enterobacteriacea if source control is not effective

Meropenem 1 g 8-hourly

or

Doripenem 500 mg 8-hourly

or

Imipenem/Cilastatin 1 g 8-hourly

In patients at high risk for infection with Enterococci including immunocompromised patients or patients with recent antibiotic exposure consider use of Ampicillin 2 g 6-hourly if the patients are not being treated with piperacillin/tazobactam or imipenem/cilastatin (active against ampicillin-susceptible enterococci)

Empiric antimicrobial regimens for non-critically ill patients with healthcare-associated IAIs. Normal renal function

Healthcare-associated IAIs

Non-critically ill patients

Piperacillin/Tazobactam 4.5 g 6-hourly

or

In patients at higher risk for infection with MDROs including recent antibiotic exposure, patient living in a nursing home or long-stay care with an indwelling catheter, or post-operative IAI if source control is not effective

Meropenem 1 g 8-hourly

or

Doripenem 500 mg 8-hourly

or

Imipenem/Cilastatin 1 g 8-hourly

or

As a carbapenem-sparing regimen

Piperacillin/Tazobactam 4.5 g 6-hourly + Tigecycline 100 mg initial dose, then 50 mg 12-hourly

+/-

In patients at high risk for invasive candidiasis

Fluconazole 800 mg LD then 400 mg 24-hourly

In patients with documented beta-lactam allergy consider use of antibiotic combinations with Amikacin 15–20 mg/kg 24-hourly

Empiric antimicrobial regimens for critically ill patients with healthcare-associated IAIs. Normal renal function

Healthcare-associated IAIs

Critically ill patients

Meropenem 1 g 8-hourly

or

Doripenem 500 mg 8-hourly

or

Imipenem/Cilastatin 1 g 8-hourly

or

As a carbapenem-sparing regimen

Ceftolozane /Tazobactam 1.5 g 8-hourly + Metronidazole 500 mg 6-hourly

or

Ceftazidime/Avibactam 2.5 g 8-hourly + Metronidazole 500 mg 6-hourly

+

Vancomycin 25–30 mg/kg loading dose then 15–20 mg/kg/dose 8-hourly

or

Teicoplanin 12 mg/kg 12-hourly times 3 loading dose then 12 mg/kg 24-hourly

or

In patients at risk for infection with vancomycin-resistant enterococci (VRE) including patients with previous enterococcal infection or colonization, immunocompromised patients, patients with long ICU stay, or recent Vancomycin exposure

Linezolid 600 mg 12-hourly

or

Daptomycin 6 mg/kg 24-hourly

+-

In patients at high risk for invasive candidiasis

Echinocandins: caspofungin (70 mg LD, then 50 mg daily), anidulafungin (200 mg LD, then 100 mg daily), micafungin (100 mg daily) or Amphotericin B Liposomal 3 mg/kg/dose 24-hourly

In patients with suspected or proven infection with MDR (non-metallo-beta-lactamase-producing) Pseudomonas aeruginosa consider use of antibiotic combinations with Ceftolozane /Tazobactam

In patients with suspected or proven infection with carbapenemase-producing Klebsiella pneumoniae consider use of antibiotic combinations with Ceftazidime/Avibactam

In patients with documented beta-lactam allergy consider use of antibiotic combinations with Amikacin 15–20 mg/kg 24-hourly