Cholecystitis - Healthcare Associated

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.

Target therapy once biliary cultures available.

If no growth or no enterococcal growth discontinue vancomycin.

Vancomycin 25-30mg/kg IV load (max 2g) followed by 15mg/kg IV q12h maintenance for a target trough of 15-20µg/mL

AND

Piperacillin-tazobactam 3.375 gm IV q6h

OR

Meropenem 500 mg IV q8h or 1 gm IV q8h

OR

Imipenem-Cilastin 500 mg IV q6h or 1000mg IV q8h

OR

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)

Vancomycin 25-30mg/kg IV load (max 2g) followed by 15mg/kg IV q12h maintenance for a target trough of 15-20µg/mL

AND EITHER

Ciprofloxacin 400mg IV q12h OR Levofloxacin 750mg IV q24h

AND

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

Consider ID Consultation in the immunocompromised patient