Intra-abdominal sepsis including hepatobiliary
Drug details
1st Line
See ward poster for sequence of drug administration
IV gentamicin - refer to NHS Highland gentamicin guidelines
PLUS IV amoxicillin 1g 3 times daily
PLUS IV metronidazole 500mg 3 times daily
7 to 10 days
For infections arising within 24 hours of surgery where gentamicin has been given as part of surgical prophylaxis substitute IV aztreonam 2g every 6 hours for gentamicin
1st line if Penicillin allergy
IV ciprofloxacin 400mg IV every 8 hours (see BNF warnings and MHRA Drug Safety Alert)
PLUS IV vancomycin - refer to NHS Highland vancomycin guidelines
PLUS IV metronidazole 500mg 3 times daily
7 to 10 days
Where vancomycin cannot be used, substitute with teicoplanin and follow the doses for use in infections with sepsis.
If no positive Microbiology result, step down to oral.
If a pathogen has been isolated, therapy should be targeted against that organism with advice from Microbiology as necessary.
Oral co-trimoxazole 960mg twice daily
PLUS oral metronidazole 400mg 3 times daily
7 to 10 days
Cautions for co-trimoxazole use: in renal impairment or in combination with other drugs which promote hyperkalaemia, monitor potassium levels if used for longer than 3 days.
In renal impairment (CrCl 30ml/min or less)
Oral co-trimoxazole 480mg twice daily
PLUS oral metronidazole 400mg three times daily
7 to 10 days
Cautions for co-trimoxazole use: in renal impairment or in combination with other drugs which promote hyperkalaemia, monitor potassium levels if used for longer than 3 days.
Timely administration in sepsis is vital, ensure agents covering gram negative pathogens (gentamicin or ciprofloxacin) are given first.
In severe illness, unresponsive to first-line therapy, contact Microbiologist for advice.
For glossary of terms see Glossary