Antimicrobial Treatmdent of

Table 3 Recommendations for initial therapy of different forms of secondary peritonitis.

Diagnosis	Likely organism	Initial therapy	Level of evidence	Strength of recommendation
Community-acquired localized peritonitis (e.g. recently perforated appendicitis)	Enterobacteriaceae Enterococci	Cephalosporin group 2 /3a + metronidazole	1/1	A/A
	Anaerobes	Aminopenicillin/BLI	1	A
		Acylaminopenicillin/BLI	1	A
		Ciprofloxacin* + Met.	1	B
Community-acquired diffuse peritonitis +- risk factors (e.g. perforated colonic carcinoma)	Enterobacteriaceae Enterococci	Cephalosporin group 3a + metronidazole	1	A
	Anaerobes	Acylaminopenicillin/BLI	1	A
		Imipenem-Cilastatin	1	A
		Meropenem	1	A
		Doripenem	1	A
		Ertapenem	1	A
		Moxifloxacin	1	A
		Tigecycline	1	B
		Cefepime	1	B
		Ciprofloxacin*+ Met.	1	B
		Levofloxacin* + Met.	1	B
Nosocomial postoperative, post-traumatic or post-interventional diffuse peritonitis (e.g. anastomotic leakage following ileotransversostomy)	Enterobacteriaceae	Imipenem-Cilastatin	1	A
	Enterococci	Meropenem	1	A
	Anaerobes	Doripenem	1	A
	Staphylococci	Acylaminopenicillin/BLI	1	A
		Ertapenem#	1	A
		Tigecycline#	2	A
		Moxifloxacin	1	B
	MRSA VRE ESBL	see Table 5
	Candida spp.	see Table 6

BLI = Beta-lactamase inhibitor, MRSA = Methicillin resistant S. aureus, VRE = Vancomycin-resistant Enterococcus spp., ESBL = extended spectrum beta-lactamase producing species, met. = metronidazole, + = Combination with antibiotics covering gram negative and anaerobic species required, # = Combination with Pseudomonas-active antibiotics required if Pseudomonas is suspected; * = use antibiotic only if local susceptibility rates are ≥ 90%.

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