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Pathogens
Antimicrobials
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.
Target therapy once biliary cultures available taking into account the pathogenic potential and amount of organism identified.
Piperacillin-tazobactam 3.375 gm IV q6h
OR
Meropenem 500 mg IV q8h or 1 gm IV q8h
Imipenem-Cilastin 500 mg IV q6h or 1,000 mg IV q8h
Cefepime 2 gm IV q8-12h
Note: For cefepime monotherapy, anaerobic coverage not necessary unless patient has biliary-enteric anastamosis (in which case add metronidazole 500mg IV q12h)
Ciprofloxacin 400mg IV q12h OR Levofloxacin 750mg IV q24h
AND
Gentamicin 5mg/kg IV q24h target trough <1mcg/mL
ALSO CONSIDER
Anaerobic coverage not necessary unless patient has biliary-enteric anastamosis (in which case add metronidazole 500mg IV q12h)
Consider ID Consultation in the immunocompromised patient
Day 3 Bundle
