GGC Medicines


Adult Therapeutics Handbook

Peritonitis, intra-abdominal sepsis or biliary tract infection
Infection

Peritonitis* or

Suspected intra-abdominal sepsis* (≥2 of SIRS criteria) or

Biliary tract infection* (cholangitis, cholecystitis)

Antibiotic Therapy (before prescribing carefully read the Notes / Comments section below)

Gentamicin** IV (dosing info here)

and

Amoxicillin IV 1g 8 hourly

and

Metronidazole IV 500mg 8 hourly


If eGFR 10-20ml/minute/1.73m2 prescribe above but replace gentamicin with:

Temocillin IV 2g every 24 hours

If eGFR <10ml/minute/1.73m2 prescribe above and replace gentamicin with:

Temocillin IV 2g every 48 hours


If true penicillin / beta-lactam allergy (anaphylaxis):

Gentamicin** IV (dosing info here)

and

Vancomycin IV (dosing info here)

and

Metronidazole IV 500mg 8 hourly


If true penicillin / beta-lactam allergy (anaphylaxis) and eGFR <20ml/minute/1.73m:

Vancomycin IV (dosing info here)

and

Metronidazole IV 500mg 8 hourly

and

Ciprofloxacin# IV/oral (see BNF for dose recommendations)

 

Total course duration: up to 7 days but dependent on clinical review and source control.

Notes / Comments

Organisms associated with intra-abdominal sepsis include: coliforms, Enterococci, Streptococci e.g. Strep milleri and anaerobes.

Gram negative cover with gentamicin (or temocillin) is essential in empirical management.

Anaerobes are rare in biliary tract infections but are associated with a more severe clinical illness. Metronidazole is not routinely required. 

*Antibiotics are not required in:

  • Biliary colic without sepsis
  • Mild diverticulitis without sepsis and with no evidence of perforation on CT scan
  • Acute pancreatitis unless there is co-existent cholangitis, suggested by jaundice and sepsis (see SIRS criteria).

**Gentamicin - do not continue gentamicin for longer than 3-4 days.

#Ciprofloxacin - QTc prolongation. Absorption reduced by oral iron, calcium, magnesium and some nutritional supplements. 

Content last updated December 2018