Intra-Abdominal Infections

Acute Abdomen (including Cholecystitis/Cholangitis with bilary stent,Appendicitis Bilary sepsis and Peritonitis )

1st Line

IV Amoxicillin 1g three times daily

+

IV Metronidazole 500mg three times daily

+

IV Gentamicin (see guideline for dosing)

step down PO Co-Amoxiclav 625mg 8 hourly (375mg if low body weight )

 

2nd line allergy

IV Vancomycin +  IV Gentamicin + IV Metronidazole 500mg 8 hourly

Step down to PO Ciprofloxacin 500mg 12 hourly + PO Metronidazole 400mg 8 hourly

Acute Abdomen with severe sepsis/septic shock

1st Line

IV Piperacillin / Tazobactam 4.5g TID

Step down to Co-Amoxiclav 625mg 8 hourly (375mg in low body weight.

 

2nd line allergy

IV Vancomycin + IV Gentamicin + IV Metronidazole 500mg 8 hourly

Step down to PO Ciprofloxacin 500mg 12 hourly + PO Metronidazole 400mg 8 hourly

Step down to  PO Ciprofloxacin  500mg BD + PO Metronidazole 400mg TID

Suspected bowel spillage

Add IV Metronidazole 500mg 8 hourly

Spontaneous Bacterial Peritonitis

1st Line

IV Co-Amoxiclav 1.2g 8 Hourly

2nd Line

Po Ciprofloxacin 500mg BD

7 DAYS TREATMENT

Infective diarrhoea with fever / sepsis Check blood film, platelets and urea. Contact microbiology. Fluid replacement essential

1ST Line

IV Ceftriaxone 1g OD

2nd Line

PO Ciprofloxacin 500mg BD

Traveller’s diarrhoea / Enteric fever /typhoid/ paratyphoid,Liver abscess

Discuss with duty microbiologist

Clostridium difficile associated disease (CDI)

Follow algorithm on NHS D & G Hippo site