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Table 7 Calculated antibiotic therapy with necrotising pancreatitis and secondary cholangitis.

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
Necrotizing pancreatitis without infection none none 1 A
Necrotizing pancreatitis with infected necrosis Enterobacteriaceae Imipenem-Cilastatin 1 A
  Enterococci Meropenem 1 A
  Staphylococci Ertapenem# 1 A
   Acylaminopenicillin/BLI 1 A
   Ciprofloxacin* + Met. 1 B
   Levofloxacin* + Met. 1 B
   Cephalosporin group 2 + Metronidazole 1 B
  MRSA
VRE
ESBL
see Table 5   
  Candida spp. see Table 6   
Secondary cholangitis Enterobacteriaceae Aminopenicillin/BLI 1 A
  Enterococci Ciprofloxacin* + Met. 1 B
  Anaerobes Levofloxacin* + Met. 1 B
   Acylaminopenicillin/BLI 1 A
   Ceftriaxon 1 B
   Imipenem-Cilastatin 1 A
   Meropenem 1 A
   Ertapenem# 1 A
   Cefepime 3 B
  Pseudomonas spp. see Table 5   
  1. (BLI = Beta-lactamase inhibitors, met. = Metronidazole, MRSA = Methicillin resistant S. aureus, VRE = Vancomycin-resistant Enterococcus spp., ESBL = extended spectrum beta-lactamase producing species, # = Combination with Pseudomonas-active antibiotics required if Pseudomonas is suspected; * = use antibiotic only if local susceptibility rates are ≥90%.