Infected abdominal collections associated with pancreatic transplant
- Suspected deep surgical site infection, usually necessitates return to theatre or pus drainage percutaneously
- Consult Micro/ID
- Perform Septic screen
- Send specimens (pus, tissue, etc.) collected at laparotomy for culture
- Treat for up to 7 days (review at 72 hours)
- Tailor therapy according to culture results and susceptibility tests
Preferred
piperacillin-tazobactam 4.5g iv tds AND caspofungin iv (see dosing table below)
If the patient has had caspofungin as part of peri-operative prophylaxis in the last 24 hours omit the loading dose and continue with maintenance dose.
| Caspofungin IV dose | |
| Body weight up to 80kg |
Loading dose: 70mg iv od for 1 day Maintenance dose: 50mg iv od |
| Body weight 80kg or more |
Loading dose: 70mg iv od for 1 day Maintenance dose: 70mg iv od |
|
Concurrent use of enzyme inducers* (Regardless of weight) |
Loading dose: 70mg iv od for 1 day Maintenance dose: 70mg iv od |
|
Moderate hepatic impairment (Child-Pugh score 7 to 9) (Regardless of weight) |
Loading dose: 70mg iv od for 1 day Maintenance dose: 35mg iv od |
*Phenytoin, carbamazepine, dexamethasone or rifampicin. This list is not exhaustive, check BNF and SPC for interactions.
For MRSA positive patients: ADD vancomycin iv
Alternative
ceftazidime 1g iv tds AND caspofungin iv (see dosing table below)
If the patient has had caspofungin as part of peri-operative prophylaxis in the last 24 hours omit the loading dose and continue with maintenance dose.
| Caspofungin IV dose | |
| Body weight up to 80kg |
Loading dose: 70mg iv od for 1 day Maintenance dose: 50mg iv od |
| Body weight 80kg or more |
Loading dose: 70mg iv od for 1 day Maintenance dose: 70mg iv od |
|
Concurrent use of enzyme inducers* (Regardless of weight) |
Loading dose: 70mg iv od for 1 day Maintenance dose: 70mg iv od |
|
Moderate hepatic impairment (Child-Pugh score 7 to 9) (Regardless of weight) |
Loading dose: 70mg iv od for 1 day Maintenance dose: 35mg iv od |
*Phenytoin, carbamazepine, dexamethasone or rifampicin. This list is not exhaustive, check BNF and SPC for interactions.
For MRSA positive patients: ADD vancomycin iv