Sandbox/intraabdominal

Initial Empiric Treatment of Extra-biliary Community-acquired Complicated Intra-abdominal Infection

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Pediatric patients   ▸  Single agent   ▸  Combination Adults, mild-to-moderate severity   ▸  Single agent   ▸  Combination Adults, high risk or severity   ▸  Single agent   ▸  Combination

Single agent ▸ Ertapenem 3 months to 12 years 15 mg/kg IV q12h; >13 years 1 g IV q24h OR ▸ Meropenem 60 mg/kg/day IV q8h OR ▸ Imipenem/Cilastatin 60-100 mg/kg/day IV q4-6h OR ▸ Ticarcillin-Clavulanate 200-300 mg/kg/day IV q12h OR ▸ Piperacillin-Tazobactam 200-300 mg/kg/day IV q6-8h Combination ▸ Ceftriaxone 50-70 mg/kg/day IV q12-24h OR ▸ Cefotaxime 150-200 mg/kg/day IV q6-8h OR ▸ Cefepime 100 mg/kg/day IV q12h OR ▸ Ceftazidime 150 mg/kg/day IV q8h PLUS ▸ Metronidazole 30-40 mg/kg/day IV q8h OR ▸ Gentamicin 3-7.5 mg/kg/day IV q2-4h OR ▸ tobramycin 3-7.5 mg/kg/day IV q8-24h PLUS ▸ Metronidazole 30-40 mg/kg/day IV q8h OR ▸ Clindamycin 20-40 mg/kg/day IV q6-8h WITH OR WITHOUT ▸ Ampicillin 200 mg/kg/day IV q8-24h Single agent ▸ Cefoxitin 2 g IV q6h OR ▸ Ertapenem 1 g IV q24h OR ▸ Moxifloxacin 400 mg IV q24h OR ▸ Tigecycline 100 mg initial dose, then 50 mg IV q12h OR ▸ Ticarcillin-Clavulanic acid 200 mg/kg/day IV q6h Combination ▸ Cefazolin 1-2 g IV q8h OR ▸ Cefuroxime 1.5 g IV q8h OR ▸ Ceftriaxone 1-2 g IV q12-24h OR ▸ Cefotaxime 1-2 g IV q6-8h OR ▸ Ciprofloxacin 400 mg IV q12h OR ▸ Levofloxacin 750 mg IV q24h PLUS ▸ Metronidazole 500 mg IV q8-12h or 1.5 g q24h Single agent ▸ Imipenem-Cilastatin 500 g IV q6h or 1 g q8h OR ▸ Meropenem 1 g IV q8h OR ▸ Doripenem 500 g IV q8h OR ▸ Piperacillin-Tazobactam 3.375 g IV q6h† † For Pseudomonas aeruginosa may be increased to 3.375 g q4h or 4.5 g q6h . Combination ▸ Cefepime 2 g IV q8-12h OR ▸ Ceftazidime 2 g IV q8h OR ▸ Ciprofloxacin 400 g IV q12h OR ▸ Levofloxacin 750 mg IV q24h PLUS ▸ Metronidazole 500 mg IV q8-12h or 1.5 g q24h

Empiric Antimicrobial Therapy for Health Care-Associated Complicated Intra-abdominal Infection

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Multidrug resistant gram-negative bacilli   ▸  Recommended Regimen ESBL-Enterobacteriaceae   ▸  Recommended Regimen Pseudomonas aeruginosa >20% resistant to ceftazidime   ▸  Recommended Regimen MRSA   ▸  Recommended Regimen

Recommended Regimen Carbapenem ▸ Meropenem 1 g IV q8h OR ▸ Imipenem/Cilastatin 500 g IV q6h or 1 g q8h OR ▸ Doripenem 500 g IV q8h Cephalosporin-based ▸ Ceftazidime 200-300 mg/kg/day IV q12h OR ▸ Cefepime 200-300 mg/kg/day IV q12h PLUS ▸ Metronidazole 500 mg IV q8-12h or 1.5 g q24h Penicillin-based ▸ Piperacillin-Tazobactam 3.375 g q4h or 4.5 g q6h Recommended Regimen Carbapenem ▸ Meropenem 1 g IV q8h OR ▸ Imipenem/Cilastatin 500 g IV q6h or 1 g q8h OR ▸ Doripenem 500 g IV q8h Penicillin-based ▸ Piperacillin-Tazobactam 3.375 g IV q6h Recommended Regimen Carbapenem ▸ Meropenem 1 g IV q8h OR ▸ Imipenem/Cilastatin 500 g IV q6h or 1 g q8h OR ▸ Doripenem 500 g IV q8h Penicillin-based ▸ Piperacillin-Tazobactam 3.375 g IV q6h Recommended Regimen ▸ Vancomycin 1-2 g IV q8h

Initial Empiric Treatment of Biliary Infection in Adults

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Community-acquired acute cholecystitis of mild-to-moderate severity   ▸  Recommended Regimen Community-acquired acute cholecystitis of severe physiologic disturbance, advanced age, or immunocompromised state   ▸  Recommended Regimen Acute cholangitis following bilio-enteric anastamosis of any severity   ▸  Recommended Regimen Health care–associated biliary infection of any severity   ▸  Recommended Regimen

Recommended Regimen ▸ Cefazolin 1 g IV q8h OR ▸ Cefuroxime 500 g IV q6h or 1 g q8h OR ▸ Ceftriaxone 500 g IV q8h Recommended Regimen ▸ Meropenem 1 g IV q8h OR ▸ Imipenem/Cilastatin 500 g IV q6h or 1 g q8h OR ▸ Doripenem 500 g IV q8h OR ▸ Piperacillin-Tazobactam 3.375 g IV q6h OR ▸ Ciprofloxacin 500 g IV q8h OR ▸ Levofloxacin 500 g IV q8h OR ▸ Cefepime 500 g IV q8h PLUS ▸ Metronidazole 500 g IV q8h Recommended Regimen ▸ Meropenem 1 g IV q8h OR ▸ Imipenem/Cilastatin 500 g IV q6h or 1 g q8h OR ▸ Doripenem 500 g IV q8h OR ▸ Piperacillin-Tazobactam 3.375 g IV q6h OR ▸ Ciprofloxacin 500 g IV q8h OR ▸ Levofloxacin 500 g IV q8h OR ▸ Cefepime 500 g IV q8h PLUS ▸ Metronidazole 500 g IV q8h Recommended Regimen ▸ Meropenem 1 g IV q8h OR ▸ Imipenem/Cilastatin 500 g IV q6h or 1 g q8h OR ▸ Doripenem 500 g IV q8h OR ▸ Piperacillin-Tazobactam 3.375 g IV q6h OR ▸ Ciprofloxacin 500 g IV q8h OR ▸ Levofloxacin 500 g IV q8h OR ▸ Cefepime 500 g IV q8h PLUS ▸ Metronidazole 500 g IV q8h PLUS ▸ Vancomycin 1-2 g IV q8h