Abdominal Flashcards
Bacteria in Gut
Gram +: Entero (E. coli, Kleb, P. mirabilis)
Gram -: Strep spp, E. face, S. aureus
Anaerobes: B. fragilis, P spp, Fuso spp, Clos, Pepto, Eubacterium
Signs/Sx
-Abdominal pain (acute, rapid onset)
-NV, loss of appetite, bloating
-Fever, tender, tachy
CT, cultures
Enterococcal coverage IF
-post op infection
-received cephalosporins or abx not for entero
-IC
-valvular heart disease or prosthetic valve
vpic
MRSA and gram + coverage IF
-advanced age
-co-morbid conditions
-previous hospitalization/surgery
-abx exposure
-known colonization of mrsa
hocac
Community Acquired TX
Mild to Mod
-Single agent: FOX, ERTA, MOXI, TIGE, TICA/CLAV (FMTET)
-Combo: FAZOLIN, FUROX, TRIAX, TAX, CIPRO, LEVO (ALL WITH METRO) (FFTTCL) *faz, lev, cip, xxx with mtz)
Severe
-Single: IMI, MERO, DORI, ZOSYN (DIMZ)
-Combo: PIME, DIME, CIPRO, LEVO (ALL WITH METRO) (PDMCL)
Healthcare Acquired TX
< 20 resistant pseudomonas, ESBL entero, Acine:
-Carbapenem, Zosyn, TAZ/PIME with METRO (tpm, mzp)
ESBL entero OR > 20:
-CARB, ZOSYN, AG
MRSA:
-VANCO
Appendicitis
Mild/Mod: Ceftriaxone, METRO
Severe: Zosyn
TMZ
Cholecystitis/Cholangitis
Mild/Mod: Ceftriaxone
Severe: Zosyn
Cholecystitis/ Cholangitis with biliary-enteric
anastomosis
Mild/Mod: Ceftriaxone, METRO
Severe: Zosyn
Duration
24 hr:
-operated on within 12-24 hr
-acute titis without perforation
-ischemia non-perf bowel
If adequate source control then 4-7 days
-inadequate: 5-7
If bacteremia secondary to IAI:
-7 day after cultures, if S. aureus then 14 day min
Peritonitis
-Culture neg but PMN > 250: treat
-If no signs/sx, PMN < 250, culture is pos: don’t treat
Peritonitis TX
-Ceftriaxone 2 g IV QD
-Cefotaxime 2 g IV Q8
-OR cipro 400 mg IV QD or 500 mg PO BID
Duration: 5-7 days
Prophylaxis
Used in:
-cirrhosis, GI bleeding, SBP hx, ascitic fluid protein <1.5 if LF/RF or <1 if hospitalized
Options:
-cirrhosis/GI: Ceftriaxone 1 g IV QD
-SBP: Cipro 500 mg PO QD
-Alt: TMP/SMX 1 tab PO QD
For 7 days, SBP = indefinitely
