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Intra-­‐abdominal Infections
PHA 6784C Pharmacotherapeutics III Kristy M. Shaeer, PharmD, AAHIVP
13
Pharmacology
Professional
09/10/2013

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Term
Peritoneal
cavity
Definition
undersurface
of
the
diaphragm
to
the
floor
of
the
pelvis
containing
the
stomach,
small
intestine,
large
intestine,
liver,
gallbladder,
and
spleen
Term
Retroperitoneum
cavity
Definition
duodenum,
pancreas,
kidneys,
adrenal
glands,
great
vessels
(aorta
and
vena
cava),
and
most
mesenteric
vascular
structures
Term
Primary:Peritonitis:
Definition
k.a. spontaneous bacterial peritonitis (SBP); inflammation of the peritoneum by an extraperitoneal source, frequently occurring from hematogenous dissemination; no evident source
Term
Secondary:Peritonitis:
Definition
inflammation or mechanical break of the integrity of the intestinal or the urogenital tract or solid organs, thus exposing the peritoneal cavity to the resident GIT flora (e.g. acute peritonitis via perforation, postoperative peritonitis, or post-­‐traumatic peritonitis)
Term
Tertiary:Peritonitis:
Definition
associated with highest morbidity and mortality; persistent or recurrent 48 hrs after
intra-­‐abdominal infection, after initial treatment of a primary or secondary peritonitis
Term
Primary peritonitis Microbiology
Definition
often always a monomicrobial infection caused by enteric gram negative rods
Term
Secondary and tertiary peritonitis Microbiology
Definition
often a polymicrobial infection caused by enteric gram negative rods and
anaerobes
Term
Most common IAI bac
Definition
E coli

Escherichia coli
Klebsiella species
Pseudomonas aeruginosa 14
Proteus mirabilis
Enterobacter species
Term
Community-­‐Acquired Empiric Combination Therapy Mild-­‐Moderate
Definition
1st generation: Cefazolin (IV)
2nd generation: Cefuroxime (IV/PO)
3rd generation: Ceftriaxone (IV), Cefotaxime (IV)
-­‐Plus-­‐ Metronidazole (IV/PO)
Ciprofloxacin (IV/PO), Levofloxacin (IV/PO)
-­‐Plus-­‐ Metronidazole (IV/PO)
Term
Community-­‐Acquired Empiric Combination Therapy Severe
Definition
3rd generation: Ceftazidime (IV)
4th generation: Cefepime (IV)
-­‐Plus-­‐ Metronidazole (IV/PO)
Ciprofloxacin (IV/PO), Levofloxacin (IV/PO)
-­‐Plus-­‐ Metronidazole (IV/PO)
Gentamicin (IV), Tobramycin (IV), Amikacin (IV)
-­‐Plus-­‐ Metronidazole (IV/PO) or Clindamycin$(IV/PO)
Aztreonam (IV)δ
-­‐Plus-­‐ Metronidazole (IV/PO)
Term
Community Acquired Empiric Monotherapy Mild-­‐Moderate
Definition
Amoxicillin/Clavulanate (PO)* Ampicillin/Sulbactam (IV/PO)* Ticarcillin/Clavulanate (IV)
2nd generation: Cefoxitin (IV)γ
Moxifloxicin (IV/PO)
Ertapenem (IV)
Tigecycline∝ (IV)
Term
Community Acquired Empiric Monotherapy Severe
Definition
Piperacillin/Tazobactam (IV)
-­‐
-­‐
Imipenem/Cilastatin (IV) Doripenem (IV) Meropenem (IV)
-­‐
Aztreonam (IV)δ
-­‐Plus-­‐ Metronidazole (IV/PO)
Term
IAI Treatment duration
Definition
Duration 4-­‐7 days
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