Gastrointestinal and intra-abdominal infections

Gastrointestinal and intra-abdominal infections
Clinical condition Common pathogens Empirical antimicrobial agents Alternative antimicrobial agents Comments
Acute gastroenteritis Viral, enterotoxigenic & enteropathogenic
E. coli
None None Rehydration (oral/IV) essential
Food poisoning S. aureus, B. cereus None None Rehydration (oral/IV) essential
Cholera V. cholera Doxycycline Azithromycin
or ciprofloxacin
Rehydration (oral/IV) essential
Bacterial dysentery Shigella, Campylobacter, Salmonella, E. coli Ceftriaxone Azithromycin  
Amoebic dysentery E. histolytica Metronidazole Tinidazole Add diloxanide furoate 500mg q 8h for 7-10 days
Biliary tract infections Enterobacteriaceae Piperacillin-tazobactam or
Cefoperazone-sulbactam
or
ertapenem
Imipenem-cilastatin 500mg q 6h
or
meropenem 1g IV q 8h
Surgical or endoscopic intervention may be considered for biliary obstruction
Spontaneous bacterial peritonitis Enterobacteriaceae Piperacillin-tazobactam or
Cefoperazone-sulbactam or
ertapenem
Imipenem-cilastatin
or
meropenem
 
Secondary peritonitis, intra-abdominal abscess Enterobacteriaceae Piperacillin-tazobactam
or
Cefoperazone-sulbactam
or
ertapenem
Imipenem-cilastatin
or
meropenem
Source control is important