18.7 Intra-abdominal infection
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Tertiary Peritonitis | Imipenem- cilastatin IV 500 mg QID Or Meropenem 1g IV TDS | Cover for CRO* if patient recently exposed to BL-BLI / Carbapenems Polymyxin B 15-20 lakhs units IV stat, then 7.5-10 lakhs IV q12h Or Colistin 9MU IV stat, then 4.5 MU IV q12h Or Fosfomycin 4g IV q6h OR Tigecycline 200mg stat and 100mg IV BD In combination with a carbapenem (meropenem/imipenem) | All hospital onset infections; should be managed as per hospital antibiograms; these recommendations are general and especially for places where there is no antibiogram (it is highly recommended to generate antibiograms) Duration: 5-7 days (if source reduction is being done) Add Candida cover (Fluconazole or Echinocandin) if risk factors for candida present |
For common etiological agents of Intra-abdominal infection, see Annexure B.18.7
References
1. Bass GA, Dzierba AL, Taylor B, Lane-Fall M, Kaplan LJ. Tertiary peritonitis: considerations for complex team-based care. Eur J Trauma Emerg Surg. 2022;48(2):811-825. doi:10.1007/s00068-021-01750-9
2. Sartelli, M., Catena, F., Abu-Zidan, F.M. et al. Management of intra-abdominal infections: recommendations by the WSES 2016 consensus conference. World J Emerg Surg 12, 22 (2017). https://doi.org/10.1186/s13017-017-0132-7
3. Soman R, Veeraraghavan B, Hegde A, Varma S, Todi S, Singh RK, Nagavekar V, Rodrigues C, Swaminathan S, Ramsubramanian V, Ansari A, Chaudhry D, Pednekar A, Bhagat S, Patil S, Barkate H. Indian consensus on the managemeNt of carbapenem-resistant enterobacterales infection in critically ill patients II (ICONIC II). Expert Rev Anti Infect Ther. 2024 Jun;22(6):453-468. doi: 10.1080/14787210.2024.2360116. Epub 2024 May 27. Erratum in: Expert Rev Anti Infect Ther. 2024 Jul;22(7):607. doi: 10.1080/14787210.2024.2370086. PMID: 38790080.
4. Guidance on Diagnosis & Management of Carbapenem Resistant Gram-negative Infections. ICMR.2022 ICMR.Available from: https://www.icmr.gov.in/icmrobject/custom_data/pdf/resource-guidelines/Diagnosis_and_management_of_CROs.pdf