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For adults recovering from intraabdominal infections who are able to tolerate an
oral diet, completion of the antimicrobial course with oral forms of moxifloxacin,
ciprofloxacin or levofloxacin plus metronidazole, an oral cephalosporin with
metronidazole, or amoxicillin/clavulanic acid is acceptable provided resistant
organisms have not been isolated.
Cultures are not routinely needed unless patients have been on an antibiotic
within the last three months; then cultures should be considered and the prior
antibiotic should be taken into account in the empiric antibiotic selection.
If a lower-risk patient with a community-acquired infection is improving on empiric
therapy and source control it is not necessary to adjust therapy if unsuspected
and untreated pathogens are reported later.
2. Community-Acquired Severe Infection/High-Risk/Immunocompromised
Metronidazole PLUS cefepime or ciprofloxacin
Meropenem,* ertapenem,* moxifloxacin, tigecycline*
o Less desirable due to broad spectrum or cost
o *-ID restricted
Cultures from the site of infection should be obtained routinely especially if
the patient has had prior antibiotic exposure or is more likely to have resistant
Empiric coverage for yeast and/or MRSA is not recommended in the absence
of evidence of infection with these organisms. Empiric coverage for
Enterococcus is recommended for severe infections:
• Ampicillin
• Piperacillin/tazobactam
• Vancomycin
For transplant and severely immunocompromised patients, also refer to the
Healthcare-Associated Infection section
3. Healthcare-Associated Infection
Metronidazole PLUS cefepime or ciprofloxacin
Meropenem,* ertapenem*
o *-ID restricted
o Carbapenems do not cover the enterococci well