Infectious Diseases II: Intra-abdominal infections

Question 1

Primary peritonits

Answer 1

Spontaneous bacterial peritonitis (SBP)
infection of peritoneal space
Usual pathogens: Streptococci, Proteus, E. coli, kelbsiella

Question 2

Treatment of SBP

Answer 2

DOC: ceftriaxone x 5-7 days

ampicillin, gentamicin, quinolones

Question 3

Prophylaxis of SBP

Answer 3

SMX/TMP
Ofloxacin
Ciprofloxacin

Question 4

Causes of secondary peritonitis

Answer 4

Caused by a traumatic event (ulceration, surgery, etc.)

Pathogens: strept, Proteus, E. coli, klebsiella, anaerobes (Bacteroides)

Question 5

Cholangitis

Answer 5

infection of the common bile duct

managed with bile decompression and antibiotics

Question 6

General duration of therapy for intra-abdominal infections:

Answer 6

Mild-mod with goof source control: 4-7 days
Severe: 7-14 days
If abscess is present: 14 + days may be needed

Question 7

antibiotics for mild-mod infections

Answer 7

Cefoxitin, ertapenem, moxifloxacin (have anaerobic coverage)
Cephalosporin + metronidazole
Cipro or Levoflox + metronidazole

Question 8

antibiotics for severe infections/ pts in the ICU

Answer 8

Cover for usual pathogens + pseudomonas coverage and Enterobacter, other less common gram - pathogens

Carbapenems (except erta)
Zosyn
Cefepime/ceftazidime + metronidazole
Cipro/levofloxacin + metronidazole 
AG + metronidazole