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Table 3 Recommendations for initial therapy of different forms of secondary peritonitis.

From: Antimicrobial Treatmdent of "Complicated" Intra-Abdominal Infections and The New IDSA Guidelines - A Commentary and an Alternative European Approach According to Clinical Definitions

Diagnosis Likely organism Initial therapy Level of evidence Strength of recommendation
Community-acquired localized peritonitis (e.g. recently perforated appendicitis) Enterobacteriaceae
Cephalosporin group 2 /3a + metronidazole 1/1 A/A
  Anaerobes Aminopenicillin/BLI 1 A
   Acylaminopenicillin/BLI 1 A
   Ciprofloxacin* + Met. 1 B
Community-acquired diffuse peritonitis +- risk factors (e.g. perforated colonic carcinoma) Enterobacteriaceae
Cephalosporin group 3a + metronidazole 1 A
  Anaerobes Acylaminopenicillin/BLI 1 A
   Imipenem-Cilastatin 1 A
   Meropenem 1 A
   Doripenem 1 A
   Ertapenem 1 A
   Moxifloxacin 1 A
   Tigecycline 1 B
   Cefepime 1 B
   Ciprofloxacin*+ Met. 1 B
   Levofloxacin* + Met. 1 B
Nosocomial postoperative, post-traumatic or post-interventional diffuse peritonitis (e.g. anastomotic leakage following ileotransversostomy) Enterobacteriaceae Imipenem-Cilastatin 1 A
  Enterococci Meropenem 1 A
  Anaerobes Doripenem 1 A
  Staphylococci Acylaminopenicillin/BLI 1 A
   Ertapenem# 1 A
   Tigecycline# 2 A
   Moxifloxacin 1 B
see Table 5   
  Candida spp. see Table 6   
  1. BLI = Beta-lactamase inhibitor, MRSA = Methicillin resistant S. aureus, VRE = Vancomycin-resistant Enterococcus spp., ESBL = extended spectrum beta-lactamase producing species, met. = metronidazole, + = Combination with antibiotics covering gram negative and anaerobic species required, # = Combination with Pseudomonas-active antibiotics required if Pseudomonas is suspected; * = use antibiotic only if local susceptibility rates are ≥ 90%.