MedBalans

Secondary peritonitis

Adults · verify locally

Inpatient

First line

  • Piperacillin/tazobactam · i.v.

    4.5 g IV q6–8h

Alternatives

  • Ceftriaxone + metronidazole · i.v.

    Ceftriaxone 1–2 g daily + metro 500 mg IV tid

  • Meropenem / imipenem · i.v.

    Meropenem 1 g IV q8h (adjust per local sepsis protocol)

  • Ciprofloxacin + metronidazole · i.v.

    Cipro 400 mg IV bid + metro 500 mg IV tid

Duration

~4 days after adequate source control if clinically improving; longer if ongoing contamination

Notes

  • Source control is essential; short course after adequate surgery if improving.
  • SBP in cirrhosis is a different entity — not this card.

Blood cultures before antibiotics; intraoperative samples when feasible.

  • • SIS / IDSA complicated IAI; STOP-IT (2017)