Intra-abdominal sepsis including hepatobiliary (Antimicrobial)

Warning

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.

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 andMHRA 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.

Last reviewed: 25/08/2022

Next review date: 25/08/2025

Author(s): Antimicrobial Management Team.

Version: 2

Approved By: TAM Subgroup of ADTC

Reviewer name(s): Alison Macdonald, Area Antimicrobial Pharmacist.

Document Id: AMT121