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Secondary peritonitis

abscess
bowel perforation
ruptured appendix

- Switch to oral agents when tolerating oral intake and clinical improvement.

Usual Pathogens

Polymicrobial:

Enterobacterales
Enterococcus spp
Anaerobes
Streptococcus spp
Candida spp

Mild-moderate

Empiric Therapy	Dose	Duration
Ceftriaxone	100mg/kg IV q24h	Duration of therapy dependent on clinical picture (see Peritonitis).
+
Metronidazole	30mg/kg/d IV div q12h

Enterococcal coverage required

Empiric Therapy	Dose	Duration
Ampicillin	150-200mg/kg/d IV div q6h	Duration of therapy dependent on clinical picture (see Peritonitis).
+
Gentamicin	5-7mg/kg IV q24h
+
Metronidazole	30mg/kg/d IV div q12h

Alternative

Empiric Therapy	Dose	Duration
Clindamycin	40mg/kg/d IV div q8h	Duration of therapy dependent on clinical picture (see Peritonitis).
+
Gentamicin	5-7mg/kg IV q24h

Severe

Empiric Therapy	Dose	Duration
Piperacillin-tazobactam	240-300mg piperacillin/kg/d IV div q6-8h	Duration of therapy dependent on clinical picture (see Peritonitis).
+/-
Gentamicin	7mg/kg IV q24h	Assess need for continuation of gentamicin based on C&S results

Multiple previous antibiotics/known ESBL or AmpC

Empiric Therapy	Dose	Duration
Imipenem	60mg/kg/d IV div q6h	Duration of therapy dependent on clinical picture (see Peritonitis).
or
Meropenem	60mg/kg/d IV div q6-8h