Peritonitis

Single agent

1. β-lactam–β-lactamase inhibitor (piperacillin–tazobactam ^b^,^c)

2. Moxifloxacin^b^,^c^,^d^,^e^,^f

3. Carbapenem (imipenem^b^,^c, meropenem^c, doripenem^c, or ertapenem ^g)^d

4. Tigecycline^b^,^f^,^h

Combinations

5. Cefazolin, cefuroxime, ceftriaxone, or cefotaxime plus metronidazole

6. A third- or fourth-generation cephalosporin (ceftazidime^c or cefepime^c) plus metronidazole

7. Levofloxacin^d^,^e^,^for ciprofloxacin^c^,^d^,^e^,^fplus metronidazole

8. Aztreonam^c^,^f^,ⁱplus vancomycin plus metronidazole^b

^a These regimens should be adjusted based on the results of culture and susceptibility testing.

^b Empiric regimens with activity against Enterococcus faecalis are preferred for severe or nosocomial infections.

^c Antipseudomonal

^d The carbapenems and often fluoroquinolones, but not third-generation cephalosporins or β-lactam–β-lactamase inhibitor combinations, are active against ampC β-lactamase-producing and extended-spectrum β-lactamase (ESBL)-producing aerobic–facultative gram-negative bacilli.

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