Intra-Abdominal Infections Treatment Guidelines

Systemic Antibiotic Therapy

The World Health Organization recommends systemic antibiotic therapy as the standard of care for intra-abdominal infections, with amoxicillin-clavulanic acid as the first choice for mild to moderate community-acquired infections 2, 3
For severe intra-abdominal infections, cefotaxime or ceftriaxone + metronidazole is recommended as the first choice by the Infectious Diseases Society of America 2, 3
Gentamicin (5-7 mg/kg/day IV once daily) is specifically recommended for complicated urinary tract infections caused by carbapenem-resistant Enterobacterales by the European Society of Clinical Microbiology and Infectious Diseases 4
Aminoglycosides should be administered after fluid resuscitation to restore adequate visceral perfusion and reduce nephrotoxicity, as suggested by the American College of Clinical Pharmacy 6

Experimental studies show that antibiotic irrigation solutions may be associated with higher adhesion formation compared to saline solution, according to the World Journal of Emergency Surgery 1
Antiseptic solutions for peritoneal lavage have been associated with higher mortality (55-80%) compared to saline solution (0%) in experimental models, as reported by the World Journal of Emergency Surgery 1
The World Health Organization found low-certainty evidence regarding the effectiveness of antibacterial irrigation compared to non-antibacterial irrigation for reducing surgical site infections 1

The primary treatment for intra-abdominal infections is adequate source control through surgical intervention, as recommended by the World Society of Emergency Surgery 7
Selection of empiric antibiotic regimens should be based on clinical condition of the patient, individual risk for infection by resistant pathogens, and local resistance epidemiology, according to the Infectious Diseases Society of America 7
The infection source should be considered as etiological distribution varies according to the source site, as suggested by the European Society of Clinical Microbiology and Infectious Diseases 8