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Table 4 Recommendations for the initial therapy of tertiary 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
Persisting peritonitis despite adequate surgical and initial antimicrobial therapy Enterobacteriaceae (Enterococci) (Staphylococci) Imipenem-Cilastatin 2 A
   Meropenem 2 A
   Acylaminopenicillin/BLI 2 A
  Anaerobes Tigecycline# 2 A
   Ertapenem# 4 B
   Ceftriaxone+Metronidazole 4 B
  MRSA, VRE
ESBL
Pseudomonas spp.
see Table 5   
  Candida spp. see Table 6   
  1. # = combination therapy with pseudomonas-active agent required if Pseudomonas is suspected