Surgical Gastrointestinal Infections

Ampicillin 2g (child 50mg/kg) IV QID

PLUS

Gentamicin 4-5mg/kg (child <10 years old 7.5mg/kg) IV OD

PLUS

Metronidazole 500mg (child 12.5mg/kg) IV BID

If patient is in septic shock replace gentamicin with:

Amikacin 28mg/kg IV OD as a first dose in patients with creatinine clearance >60ml/minute. Use 16-20mg/kg if creatinine clearance <60ml/minute. For subsequent doses see Aminoglycoside dosing section.

Child 15mg/kg IV OD.

If amikacin is not available and patient is likely to have normal renal function give above regime but increase Gentamicin to 7mg/kg IV for first dose.

If still requiring IV therapy after 48 hours change to:

Ceftriaxone 2g (child 50mg/kg) IV OD

PLUS

Metronidazole 500mg (child 12.5mg/kg) IV BID

When clinically well change to oral antibiotics. If susceptibilities are unavailable use:

Amoxicillin/Clavulanic acid 500/125mg (child 25/6.25 mg/kg) PO TID

OR

Cotrimoxazole 160/800mg (child 4/20 mg/kg) PO BID

PLUS

Metronidazole 500mg (child 12.5mg/kg) PO BID

Take blood cultures prior to antibiotics. Send tissue culture from operating theatre.

If patient is septic give antibiotics within 1 hour of presentation.

Duration:

Uncomplicated appendicitis: Stop antibiotics immediately after appendi- cectomy.

Complicated appendicitis (perforation, abscess), peritonitis, perforated bowel: Change to oral antibiotics when patient is improving. Treat for a total of 5 days after surgical control of infection.

Undrained residual intra-abdominal collection or abscesses: Continue antibiotics for 4-6 weeks

See Gastrointestinal and Biliary Tree surgery prophylaxis in Chapter 1: Antibiotic Prophylaxis

Ampicillin 2g (child: 50mg/kg) IV QID

PLUS

Gentamicin 4-5mg/kg (child <10 years old: 7.5mg/kg) IV OD

If patient is in septic shock replace gentamicin with:

Amikacin 28mg/kg IV OD as a first dose in patients with creatinine clearance >60ml/minute. Use 16-20mg/kg if creatinine clearance <60ml/minute. For subsequent doses see Aminoglycoside dosing section.

Child 15mg/kg IV OD.

If amikacin is not available and patient is likely to have normal renal function give above regime but increase Gentamicin to 7mg/kg IV for first dose.

If there is cholangitis with chronic biliary obstruction or acalculous cholecystitis ADD:

Metronidazole 500mg (child 12.5mg/kg) IV BID

If still requiring IV therapy after 48 hours, change ampicillin + gentamicin to:

Ceftriaxone 2g (child 50mg/kg) IV OD.

When clinically well change to oral antibiotics. If susceptibilities are unavailable use:

Amoxicillin/Clavulanic acid 500/125mg (child 25/6.25 mg/kg) PO TID

OR

Cotrimoxazole 160/800mg (child 4/20 mg/ kg) PO BID

PLUS, if chronic biliary obstruction or acalculous cholecystitis

Metronidazole 500mg (child 12.5mg/kg) PO BID

Take blood cultures prior to antibiotics. Send tissue culture from operating theatre.

If patient is septic give antibiotics within 1 hour of presentation.

Duration:

Cholangitis with biliary drainage: Stop antibiotics 5 days after drainage.

Cholangitis without biliary drainage: Treat for 7-10 days.

Calculus cholecystitis with cholecystectomy: Stop antibiotics immediately after cholecystectomy.

Acalculous cholecystitis with cholecystectomy: Treat for 5 days after cholecystectomy

Cholecystitis without cholecystectomy: Treat for 7-10 days

See Gastrointestinal and Biliary Tree surgery prophylaxis in Chapter 1: Antibiotic Prophylaxis