Cholecystitis (HC Assoc. +VRE RFs)

Note

Duration of therapy after source control is 4-7d guided by resolution of fever, normal WBC, and benign abdomen.

Generally, longer duration of therapy for bacteremia.

Suggested Regimen

Target therapy once biliary cultures available.

If no growth or no enterococcal growth discontinue enterococcal coverage (i.e. Linezolid or Daptomycin).

Linezolid 600mg PO/IV q12h

OR

Daptomycin 4mg/kg IV daily

AND EITHER

Piperacillin-tazobactam 3.375 gm IV q6h

OR

Meropenem 500 mg IV q8h or 1 gm IV q8h

OR

Cefepime 2 gm IV q8-12h

Note: For cefepime use, anaerobic coverage not necessary unless patient has biliary-enteric anastamosis (in which case add metronidazole)

Penicillin Anaphylaxis

Linezolid 600mg PO/IV q12h

OR

Daptomycin 4mg/kg IV daily

AND EITHER

Ciprofloxacin 400mg IV q12h

AND

Gentamicin 5mg/kg IV q24h target trough <1mcg/mL

OR

Aztreonam 2g IV q8h

ALSO CONSIDER

Anaerobic coverage not necessary unless patient has biliary-enteric anastamosis (in which case add metronidazole)

Note

Consider ID Consultation in the immunocompromised patient

Reassess Therapy on Day 3