Complicated – extend beyond the hollow of the viscous origin into the peritoneal space. Associated with abscesses or peritonitis.
- Must drain, remove abscess, surgery
- Fluid resuscitation if sepsis
- Mild to moderate: cefoxitin, cefazolin, cefuroxime, ceftriaxone and metronidazole, ertapenem, moxifloxacin, cipro or levo AND metronidazole, tigecycline
- High risk or severe: pip/tazo, ceftazidime or cefepime AND metronidazole, cipro or levo AND metronidazole (unless healthcare acquired), consider adding aminoglycoside when enterobacteria or P. aeruginosa is concerned (healthcare acquired) or vanc for MRSA.
- Treat for 4-7 days.
Appendicitis: ceftriaxone and metronidazole after surgery for a ruptured appendix
Prostatitis: no beta-lactams, 4 weeks of Bactrim or 28 days of a fluoroquinolone