Clinical definition:
Suspected or confirmed peritonitis including perforation or leakage of intestinal contents into peritoneum.
Neonate | |||
| Preferred antibiotic choice | |||
| Drug | Formulation | Dosage | Duration |
| Combination therapy with: Cefotaxime (IV) PLUS Metronidazole (IV) | Cefotaxime- Powder for injection: 250 mg per vial (as sodium salt) | o First week of life (7 days or less): 50 mg/kg/dose 12 hourly o 8-20 days: 50 mg/kg/dose 8 hourly o 21 days & older: 50 mg/kg/dose 6 hourly | 5 – 10 days depending on response to clinical and surgical treatment |
| Metronidazole- Injection: 500 mg in 100- mL vial. | o First week of life (7 days or less): 7.5 mg/kg/dose 12 hourly o 8 days of age & older: 7.5 mg/kg/dose 8 hourly, maximum dose 400 mg 8 hourly | ||
| Alternative antibiotic choice(s) | |||
| Combination therapy with: Benzylpenicillin (IV) PLUS Gentamicin (IV) PLUS Metronidazole (IV)
| Benzylpenicillin- Powder for injection: 600 mg (= 1 million IU); 3 g (= 5 million IU) (sodium or potassium salt) in vial. | o First week of life (7 days or less): 100 000 IU/kg/dose 8 hourly o 8 days of age & older: 125 000 IU/kg/dose 6 hourly, maximum dose 5 million IU 6 hourly | 5 – 10 days depending on response to clinical and surgical treatment |
| Gentamicin- Injection: 10 mg; 40 mg (as sulfate)/ mL in 2- mL vial. | o 4 mg/kg/dose once daily
| ||
| Metronidazole- Injection: 500 mg in 100- mL vial. | o First week of life (7 days or less): 7.5 mg/kg/dose 12 hourly o 8 days of age & older: 7.5 mg/kg/dose 8 hourly, maximum dose 400 mg 8 hourly | ||
| If Benzylpenicillin (IV) unavailable, substitute with: Ampicillin (IV) Treat with Gentamicin (IV) PLUS Metronidazole (IV), as above. | Ampicillin- Powder for injection: 500 mg; 1 g (as sodium salt) in vial. | o First week of life (7 days or less): 50 mg/kg/dose 8 hourly o 8 days of age & older: 50 mg/kg/dose 6 hourly | |
Infant, Child & Adolescent | |||
| Preferred antibiotic choice | |||
| Drug | Formulation | Dosage | Duration |
| Combination therapy with: Ceftriaxone (IV) PLUS Metronidazole (IV) | Ceftriaxone- Powder for injection: 250 mg, 1 g (as sodium slat) in vial | 50 mg/kg/dose 12 hourly, maximum dose 2 g 12 hourly | 5 days if source control has been achieved (e.g. laparotomy, washout, repair). Longer durations may be required if source control is delayed |
| Metronidazole- Injection: 500 mg in 100- mL vial. | 7.5 mg/kg/dose 8 hourly, maximum dose 400 mg 8 hourly | ||
| Alternative antibiotic choice(s) | |||
| Amoxicillin + clavulanic acid (IV) | Powder for injection: 500 mg (as sodium) + 100 mg (as potassium salt); 1000 mg (as sodium) + 200 mg (as potassium salt) in vial. | 30 mg/kg/dose of amoxicillin component 8 hourly, maximum dose 1.2 g 8 hourly | 5 days if source control has been achieved (e.g. laparotomy, washout, repair). Longer durations may be required if source control is delayed |
| If poor response to treatment | |||
| Combination therapy with: Piperacillin/tazobactam (IV) PLUS Amikacin (IV) | Piperacillin/tazobactam Powder for injection: 2 g (as sodium salt) + 250 mg (as sodium salt); 4 g (as sodium salt) + 500 mg (as sodium salt) in vial | 100 mg/kg of piperacillin component/dose 8 hourly, maximum dose 4 g of piperacillin component 8 hourly | 5 days if source control has been achieved (e.g. laparotomy, washout, repair). Longer durations may be required if source control is delayed |
| Amikacin- Injection: 250 mg (as sulfate)/mL in 2- mL vial | 15 mg/kg/dose once daily, maximum dose 1.5 g | ||
| If piperacillin-tazobactam (IV) is not available or in case of confirmed drug allergy or medical contraindication | |||
| Ciprofloxacin (IV) PLUS Metronidazole (IV) PLUS Amikacin (IV) | Ciprofloxacin- Solution for IV infusion: 2 mg/ mL (as hyclate) | 10 mg/kg/dose 8-12 hourly, maximum dose 400 mg 8-12 hourly | 5 days if source control has been achieved (e.g. laparotomy, washout, repair). Longer durations may be required if source control is delayed |
| Metronidazole- Injection: 500 mg in 100- mL vial. | 7.5 mg/kg/dose 8 hourly, maximum dose 400 mg 8 hourly | ||
| Amikacin- Injection: 250 mg (as sulfate)/mL in 2- mL vial | 15 mg/kg/dose once daily, maximum dose 1.5 g | ||
Principles of Stewardship:
- Obtain a blood culture prior to starting antibiotic therapy.
- Investigate TB as a cause in endemic areas.
Notes:
- Consultation with a surgeon is frequently required in patients with complicated intra-abdominal infections.
- Once the patient is improving clinically and tolerating oral feeds, consider switching to an oral antibiotic such as amoxicillin + clavulanic acid.