Peptic ulcer perforation
ICD-10 K27.1 · ICD-11 DA61/ME24.3Z1

Peptic Ulcer Perforation with Normal Renal Function: Community-Acquired Intra-Abdominal Infection in the Critically Ill

This protocol covers the management of perforated peptic ulcer presenting with community-acquired intra-abdominal infection (IAI) in a critically ill patient whose renal function is normal — a specific clinical constellation that drives the choice and intensity of antibiotic therapy.

Clinical scenario: Critically ill patient with perforated peptic ulcer and community-acquired intra-abdominal infection. Normal renal function is a key factor shaping empiric antibiotic regimen selection in this setting.
Treatment approach

Management includes empiric broad-spectrum antibiotic therapy, with the specific regimen determined by the community-acquired source and the patient's renal function. Where there is risk of resistant organisms, a distinct escalated antibiotic strategy applies.

The complete regimen — including all options and escalation criteria — is in the full protocol.

Treatment goal: Normalization of inflammatory markers, with antibiotic therapy targeted to a short course once adequate source control has been achieved.
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References

Community-acquired

Empiric antibiotic regimens for critically ill patients with IAIs and Normal renal function:

Piperacillin/tazobactam 4.5 g 6-hourly or cefepime 2 g 8-hourly + metronidazole 500 mg 6-hourly

Patients at risk for infection with community-acquired ESBL-producing Enterobacteriaceae: meropenem 1 g 8-hourly or doripenem 500 mg 8-hourly or imipenem/cilastatin 1 g 8-hourly

In patients with perforated peptic ulcer, we suggest a short-course (3–5 days or until inflammatory markers normalize) antibiotic therapy (weak recommendation based on low-quality evidences, 2C).

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