Intra-Abdominal Sepsis (including appendicitis, diverticulitis, peritonitis, perianal abscess, pilonidal abscess)

Micro-organism

Coliforms, Enterococci, Anaerobes

Duration

IV + Oral: 3 - 5 days depending on degree of contamination and established infection

 

Notes
  • Surgical drainage is an important part of managing infected abscesses.
  • Send blood for culture, 2 sets if possible, and pus from operation.
  • Oral switch may not be required depending on duration of IV therapy
  • Seek specialist advice if appropriate.
Appendicitis/ Diverticulitis/Peritonitis / Perianal abscess/ Pilonidal abscess

Gentamicin¥ IV (Hartford Regimen) as per guideline

Use preferred calculator on Hospital portals page [intranet access only] or calculator on app

+

IV Metronidazole 500mg 8 hourly

+

IV Amoxicillin 1g 8 hourly

 

Oral switch

Metronidazole 400mg 8 hourly

+ Doxycycline 100-200mg daily

OR 

Metronidazole 400mg 8 hourly

+ Co-trimoxazole 960mg 12 hourly

 

¥ If >72 hours IV therapy required replace gentamicin with temocillin IV 2g 12 hourly

Appendicitis/ Diverticulitis/Peritonitis/ Perianal abscess/ Pilonidal abscess - If penicillin allergic or gentamicin not appropriate

IV Co-trimoxazole* 960mg 12 hourly

+

IV Metronidazole 500mg 8 hourly

 

Oral switch

Metronidazole 400mg 8 hourly

+ Doxycycline 100-200mg daily 

OR

Metronidazole 400mg 8 hourly

+ Co-trimoxazole 960mg 12 hourly

 *If IV co-trimoxazole not available use IV ciprofloxacin 400mg twice daily and switch to oral co-trimoxazole as soon as appropriate