Intra-Abdominal Infxns & C. diff Flashcards
SBP Empiric
- Ceftriaxone (DOC)
- Cefepime
- Zosyn
- Meropenem
IV Tx
SBP Staph/CoNS (MRSA risk)
Consider adding:
- Vanc, Linezolid, or Daptomycin
SBP Diagnosis
- S/Sx of infxn
- Ascitic Fluid Analysis (low protein fluid & ANC > 250/mm3)
SBP Anaerobic Coverage
- Zosyn
- Unasyn
- Carbapenem
- Add Metro if ceftriaxone or cefepime chosen
SBP Duration
- Cirrhosis or Ascites: 5-7d
- CAPD: 14-21d
Intraperitoneal admin of antibiotics preferred
Secondary Peritonitis Diagnosis
S/Sx of IAI AND Imaging (CT scan or X-Ray)
Secondary Peritonitis Tx Pillars
Source Control and Antimicrobial Tx
SP Community-Acquired Mild-Mod Severity
- Ceftriaxone + Metro
- Cefazolin + Metro
- Ertapenem
- Tigecycline
IV Tx
SP Community-Acquired High-Severity & Health Care-associated
- Zosyn
- Meropenem
- Cefepime + Metro
IV Tx
SP Candida albicans on culture
Fluconazole IV/PO
Candida spp. other than albicans on culture
Micafungin IV
SP Oral Options
- Augmentin
- Cefpodoxime + Metro
- Cephalexin + Metro
- Cefadroxil + Metro
- Cipro, Levo + Metro
- Bactrim + Metro
SP Tx Duration
- General Tx: 4-7d AFTER Source Control
- Uncomplicated Diverticulitis: Tx not needed
- Mod/Severe Diverticulitis: 5-10d
- Appendicitis w/out Perf, Cholecystitis w/out Perf: 24 hrs
C.Diff Initial Episode (non-severe/severe)
- Fidaxomicin or Vanc
- Metro if non-severe and other options unavailable
10d
C.Diff First Recurrence
- Fidaxo or Vanc x10d
- Fidaxo extended dosing x25d
- Vanc tapered and pulsed regimen
C.Diff Second or Subsequent Reccurence
Same options as first occurrence, but pick a different regimen strategy than previously
Fulminant C.Diff
Vanc PO + Metro IV
- Vanc via rectal if ileus present
Rebyota
- admin via rectal tube 24-72 hrs AFTER Tx completion
Vowst
- PO Tx starting 2-4 days AFTER Tx completion
- Needs a bowel prep
Bezlotoxumab
- admin via IV, 1 dose DURING course of CDI Tx
- caution in pts w/ CHF
