Which antibiotic therapies are effective in the treatment of intra-abdominal infections in sepsis/septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

For community-acquired abdominal infections, the IDSA and the Surgical Infection Society (SIS) indicate that empiric antibiotic therapies should be active against enteric gram-negative aerobic and facultative bacilli as well as enteric gram-positive streptococci. [2]

Empiric coverage is not needed for Enterococcus, nor is empiric antifungal therapy needed for Candida, unless these infections are severe. Antibiotics with activity against E faecalis include ampicillin, piperacillin-tazobactam, and vancomycin. Fluconazole is used for isolated C albicans; an echinocandin (eg, caspofungin, micafungin, or anidulafungin) is used for fluconazole-resistant Candida. [2] In critically ill patients, an echinocandin is recommended over a triazole (eg, fluconazole or itraconazole). [2]

Agents that cause healthcare-associated intra-abdominal infections include Candida, Enterococcus, and MRSA. Empiric antibiotic therapy for those infections should be based on local susceptibility results.

In adults with community-acquired infection or hospital-associated intra-abdominal infection of high severity (eg, Acute Physiology And Chronic Health Evaluation [APACHE] II score >15), broad-spectrum agents are used against gram-negative activity (eg, metronidazole plus meropenem, imipenem-cilastatin, doripenem, piperacillin-tazobactam, ciprofloxacin, or levofloxacin; alternatively, metronidazole plus ceftazidime or cefepime). [2]


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