Antimicrobial management of intra-abdominal infections: Literature's guidelines

Table 1 Antimicrobial regimens recommended by the World Society of Emergency Surgery recommendations for treating extra-biliary community-acquired intra-abdominal infections

	Antimicrobial agents	Dosage
In stable, non-critical patients
With no ESBL-associated risk factors	Amoxicillin/clavulanate	2.2 g every 6 h (2-h infusion time)
	Ciprofloxacin	400 mg every 8 h (30-min infusion time)
	+
	Metronidazole	500 mg every 6 h (1-h infusion time)
With ESBL-associated risk factors	Ertapenem	1 g every 24 h (2-h infusion time)
	Tigecycline	100 mg LD then 50 mg every 12 h (2-h infusion time)
In critically ill patients presenting
With no ESBL-associated risk factors	Piperacillin/tazobactam	9 g LD then 18 g per day via continuous infusion or 4.5 g every 6 h (4-h infusion time)
With ESBL-associated risk factors	Meropenem	500 mg every 6 h (6-h infusion time)
	or
	Imipenem	500 mg every 4 h (3-h infusion time)
	+
	Fluconazole	600 mg LD then 400 mg every 24 h (2-h infusion time)

ESBL: Extended-spectrum β-lactamase; LD: Loading dose.

Table 2 Antimicrobial regimens recommended by the World Society of Emergency Surgery recommendations for treating biliary intra-abdominal infections

	Antimicrobial agents	Dosage
In stable, non-critical patients
With no ESBL-associated risk factors	Amoxicillin/clavulanate	2.2 g every 6 h (2-h infusion time)
	Ciprofloxacin	400 mg every 8 h (30-min infusion time)
	+
	Metronidazole	500 mg every 6 h (1-h infusion time)
With ESBL-associated risk factors	Tigecycline	100 mg LD then 50 mg every 12 h (2-h infusion time)
In critically ill patients
With no ESBL-associated risk factors	Piperacillin/tazobactam	9 g LD then 18 g per day via continuous infusion or 4.5 g every 6 h (4-h infusion time)
With ESBL-associated risk factors	Piperacillin	8 g LD then 16 g/d via continuous infusion or 4 every 6 h (4-h infusion time)
	+
	Tigecycline	100 mg LD then 50 mg every 12 h (2-h infusion time)
	+/-
	Fluconazole	600 mg LD then 400 mg every 24 h (2-h infusion time)

ESBL: Extended-spectrum β-lactamase; LD: Loading dose.

Table 3 Antimicrobial regimens recommended by the World Society of Emergency Surgery recommendations for hospital-acquired intra-abdominal infections

	Antimicrobial agents	Dosage
In stable, non-critical patients	Piperacillin	8 g LD then 16 g/d via continuous infusion or 4 every 6 h (4-h infusion time)
	+
	Tigecycline	100 mg LD then 50 mg every 12 h (2-h infusion time)
	+
	Fluconazole	600 mg LD then 400 mg every 24 h (2-h infusion time)
In critically ill patients	Piperacillin	8 g LD then 16 g/d via continuous infusion or 4 every 6 h (4-h infusion time)
	+
	Tigecycline	100 mg LD then 50 mg every 12 h (2-h infusion time)
	+
	Echinocandin
	Caspofungin	(loading dose of 70 mg, then 50 mg daily)
	Anidulafungin	(loading dose of 200 mg, then 100 mg daily)
	Micafungin	(100 mg daily)
	Meropenem	500 mg every 6 h (6-h infusion time)
	or
	Imipenem	500 mg every 4 h (3-h infusion time)
	or
	Doripenem	500 mg every 8 h (4-h infusion time)
	+
	Teicoplanin	1.6 g via continuous infusion or 400 mg every 6 h (4-h infusion time)
	+
	Echinocandin
	Caspofungin	(loading dose of 70 mg, then 50 mg daily)
	Anidulafungin	(loading dose of 200 mg, then 100 mg daily)
	Micafungin	(100 mg daily)

LD: Loading dose.