Perforated Peptic Ulcer with Healthcare-Associated Intra-Abdominal Infection in a Critically Ill Patient with Normal Renal Function
Clinical Scenario
This protocol applies to perforated peptic ulcer complicated by healthcare-associated intra-abdominal infection (IAI) in a critically ill patient with normal renal function. The healthcare-associated origin of infection and the severity of illness together define the pathogen risk profile and shape antibiotic selection for this population.
Treatment Approach
Empiric treatment involves a broad-spectrum carbapenem combined with a glycopeptide; risk-stratified adjustments apply in certain patients, and the complete selection algorithm is in the full protocol.
Clinical Goals
The primary target is normalization of inflammatory markers, guided by a short-course antibiotic approach.
References
- Healthcare-associated
- 2) Empiric antimicrobial regimens for critically ill patients with IAIs normal renal function
- Meropenem 1 g 8-hourly or Doripenem 500 mg 8-hourly or Imipenem/cilastatin 1 g 8-hourly
- Vancomycin 25–30 mg/kg loading dose then 15–20 mg/kg/dose 8-hourly or Teicoplanin 12 mg/kg 12-hourly times 3 loading dose then 12 mg/kg 24-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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