Abdominal pain, Peritonitis* and Diverticulitis

*For Peritoneal Dialysis Related Peritonitis (click here). Please contact Specialist Nurse on Ward 7b GRH or the duty Nephrologist.

Severity
(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)

A

Minor to moderate infection

Antibiotic therapy may not be required. Consider a period of observation. If treatment is indicated - see schedule B/C

Not Applicable

B/C

Moderate to severe life threatening infection

 

Review doses in renal impairment

AMOXICILLIN 1g iv tds
plus
METRONIDAZOLE 500mg iv tds
plus
GENTAMICIN iv (as per local protocol)

 OR

If gentamicin is contra-indicated (see GHNHSFT protocol) then use:

AMOXICILLIN 1g iv tds
plus
METRONIDAZOLE 500mg iv tds
plus
CIPROFLOXACIN 400mg iv bd

Duration: 5 - 7 days according to clinical response

Non-Severe Penicillin Allergy:
Age less than 65 years
CEFTRIAXONE 2g iv od
plus
METRONIDAZOLE 500mg iv tds

Age 65 years and older
MEROPENEM 1g iv tds

If gross faecal contamination of peritoneum, consider adding METRONIDAZOLE 500mg iv tds

If signs of sepsis, consider adding gentamicin as a stat dose to either of the options above


 
Severe Penicillin Allergy:

TIGECYCLINE 100mg iv stat as loading. Then 50mg iv bd - first maintanence dose to be given 12 hours after loading (25mg bd maintanence dose in severe hepatic disease after loading). 

plus

GENTAMICIN iv (as per local protocol) 

If gross faecal contamination of peritoneum, consider adding METRONIDAZOLE 500mg iv tds

Duration: 5 - 7 days according to clinical response

IV to Oral Switch
(explanatory notes)

CO-AMOXICLAV 625mg po tds (monotherapy)
unless lab results indicate otherwise

Duration: 5 - 7 days according to clinical response

CIPROFLOXACIN 500mg po bd
plus
METRONIDAZOLE 400mg po tds
unless lab results indicate otherwise

 Duration: 5 - 7 days according to clinical response

Last reviewed: 09/05/17 

For guidance on the administration of intravenous antibiotics click here
(GHNHSFT intranet)