Secondary peritonitis
- abscess
- bowel perforation
- ruptured appendix
- Switch to oral agents when tolerating oral intake and clinical improvement.
Usual Pathogens
Polymicrobial:
Enterobacterales
Anaerobes
Streptococcus spp
Community-acquired, low risk
| Therapy | Dose | Duration |
| Ceftriaxone | 100mg/kg IV q24h | Duration of therapy dependent on clinical picture (see Peritonitis) |
| + | ||
| Metronidazole | 30mg/kg/d IV div q12h |
Alternative
| Therapy | Dose | Duration |
| Amoxicillin-clavulanate |
≥ 3 months old (4-40kg): 5:1 ratio: 75mg-15mg/kg/d IV div q8h |
Duration of therapy dependent on clinical picture (see Peritonitis) |
Penicillin and ceftriaxone allergy
| Therapy | Dose | Duration |
| Clindamycin | 40mg/kg/d IV div q8h | Duration of therapy dependent on clinical picture (see Peritonitis) |
| + | ||
| Gentamicin | 5-7mg/kg IV q24h |
Community-acquired, high risk:
ICU/critically ill
diffuse peritonitis
delayed or inadequate source control
or
Healthcare-associated
| Therapy | Dose | Duration |
| Piperacillin-tazobactam | 240-300mg piperacillin/kg/d IV div q6-8h | Duration of therapy dependent on clinical picture (see Peritonitis) |
| Micafungin | 2-4mg/kg IV daily | |
| If healthcare-associated and postoperative infection, add: | ||
| Vancomycin | 60mg/kg/d IV div q6h | |
Penicillin allergy/Multiple previous antibiotics/known ceftriaxone-resistant Gram negative organism
| Therapy | Dose | Duration |
| Meropenem | 60mg/kg/d IV div q6-8h | Duration of therapy dependent on clnical picture (see Peritonitis) |
| Micafungin | 2-4mg/kg IV daily | |
| If healthcare-associated and postoperative infection, add: | ||
| Vancomycin | 60mg/kg/d IV div q6h | |