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ABX – Intra-Abdominal Infections

Cholangitis OR Cholecystitis

Unasyn 1.5 grams IV every 6 hours

In obese patients, use Unasyn 3g.

Acute cholecystitis is primarily an inflammatory process, however secondary infection of the gallbladder can occur as a result of cystic duct obstruction and bile stasis resulting in cholangitis.

Uncomplicated Diverticulitis – No Recent Hospitalization*

Cefazolin 1gm IV every 8 hours + Flagyl 500 mg IV every 8 hours (recommended as first line based on Mount Sinai antibiogram)

OR

Levaquin 500 mg po once every 24 hours + Flagyl 500 mg po every 8 hours

In obese patients use Cefazolin 2g.

Community isolates of E.Coli are 89% sens to Cefazolin, but only 81% sens to Fluroquinolones as per 2005 ED antibiogram. Agents that are used to treat nosocomial infections in the intensive care unit should not be routinely used to treat community-acquired infections which are principally Gram negative rods and anaerobes (particularly E. coli and B. fragilis), using broader-spectrum antibiotics would contribute to the development of resistance.

Uncomplicated Diverticulitis – Recent Hospitalization*

Ceftriaxone 1 gm IV every 24 hours + Flagyl 500 mg IV every 6 hours (recommended as first line based on Mount Sinai antibiogram)

OR

Unasyn 1.5 grams IV every 6h.

In obese patients use ceftriaxone 2g instead of 1g or Unasyn 3g.

*Recent Hospitalization: Within the past three months or frequent hospitalizations (>3) within the past year.

Appendicitis – No Recent Hospitalization*

Cefazolin 1gm IV every 8 hours + Flagyl 500 mg IV every 8 hours

Community isolates of E.Coli are 89% sens to Cefazolin, but only 81% sens to fluroquinolones as per 2005 ED antibiogram.

Appendicitis – Recent Hospitalization*

Ceftriaxone 1 gm IV every 24 hours + Flagyl 500 mg IV every 6 hours (recommended as first line based on Mount Sinai antibiogram)

OR

Unasyn 1.5 grams IV every 6 hours.

*Recent Hospitalization: Within the past three months or frequent hospitalizations (>3) within the past year.

SBP in Cirrhotic Patients – Not on Furoquinolone Prophylaxis

Cefotaxime 2 g IV every 8 hours

Most cases of SBP are due to gut bacteria, such as Escherichia coli and Klebsiella. Dosing of cefotaxime 2 g intravenously every eight hours produces excellent ascitic fluid levels.

Written by phil

July 15th, 2006 at 3:36 pm

Posted in Antibiotics