Intra-abdominal and biliary infection (including systemic infection / sepsis)

Antimicrobial prescribing: NHS Forth Valley
NHS Forth Valley

First Line

Therapy

Gentamicin IV as per protocol 

AND

Amoxicillin 1g IV 8 hourly

AND

Metronidazole 400mg PO 8 hourly

Notes:

Metronidazole is highly bioavailable so IV should only be used if oral route is compromised and/or concerns with GI absorption, patient NBM. If sepsis or severe systemic infection first dose of metronidazole should be given IV (500mg).

If concerns regarding nephrotoxicity e.g. acute kidney injury - replace Gentamicin with Temocillin IV dosed per Renal Drug Database

Penicillin Allergy

Therapy

Gentamicin IV as per protocol

AND

Vancomycin IV as per protocol

AND

Metronidazole 400mg PO 8 hourly

Notes:

Metronidazole is highly bioavailable so IV should only be used if oral route is compromised and/or concerns with GI absorption, patient NBM. If sepsis or severe systemic infection first dose of metronidazole should be given IV (500mg).

If concerns regarding nephrotoxicity e.g. acute kidney injury - replace Gentamicin with Aztreonam IV dosed per Renal Drug Database

Notes

Infected biliary / gastric surgery/ cholecystitis / upper GIT pre - and post-surgery / peritonitis / large bowel sepsis

DO NOT omit Gentamicin from regime unless adding alternative Gram negative bacterial cover.

  • Review use of gentamicin at 3 days with microbiology results and clinical response. 
  • In treatment failure or for rationalisation of therapy then discuss with senior clinician 


Treatment duration: 5-7 days (unless evidence of complicated infection e.g. abscess, collection)

 

Oral switch guidance

Review culture results first. If no positive microbiology to guide:

Preferred regime - Co-amoxiclav 625mg PO 8 hourly

Alternative - Co-trimoxazole 960mg PO 12 hourly AND Metronidazole 400mg 8 hourly