Parenteral empiric antibiotic options for posthysterectomy abscess

Antibiotic regimen	Adult dose*
Piperacillin-tazobactam^¶	3.375 g IV every 6 hours
OR
Clindamycin	900 mg IV every 8 hours
PLUS
Ceftriaxone	2 g IV every 24 hours
OR
Metronidazole	500 mg IV every 8 hours
PLUS
Ceftriaxone	2 g IV every 24 hours
OR
Ertapenem^Δ	1 g IV every 24 hours
OR
Ticarcillin-clavulanate^◊	3.1 g IV every 6 hours
Option for patients with severe hypersensitivity to penicillins or cephalosporins
Aztreonam	1 g IV every 8 hours
PLUS
Clindamycin	900 mg IV every 8 hours

These options reflect the expert opinion of UpToDate contributors and are not an exclusive list. The choice of antibiotic agent and dose should be individualized on the basis of patient history, local practice patterns, local community resistance prevalence, and availability.

IV: intravenously.
* The doses recommended above are intended for patients with normal renal function; the doses of some of these agents must be adjusted in patients with renal insufficiency.
¶ This is our preferred regimen. An extended infusion of piperacillin-tazobactam (eg, 3.375 g infused over 4 hours every 8 hours) is an alternative dosing strategy for critically ill patients or for pathogens with elevated but susceptible minimum inhibitory concentrations. Benefits over standard dosing have been suggested by some studies but not all. The extended infusion dosing regimen is at least equivalent to standard dosing and may be superior in selected patient populations.
Δ Ertapenem and other carbapenems are generally reserved for patients who have suspected or documented infection with resistant gram-negative bacilli, such as extended-spectrum beta-lactamase (ESBL) producing Escherichia coli or Klebsiella pneumoniae.
◊ Ticarcillin-clavulanate is not available in the United States.

Adapted from: Jaiyeoba O. Postoperative infections in obstetrics and gynecology. Clin Obstet Gynecol 2012; 55:904.

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Parenteral empiric antibiotic options for posthysterectomy abscess