Community-associated infected aneurysms in adults without sepsis or septic shock

For empirical therapy of community-associated infected aneurysms in adults without sepsis or septic shock, after taking 3 sets of blood samples for culture (ideally from separate venipuncture sites), a suitable regimen is:

vancomycin intravenously; for initial dosing, see Vancomycin dosing in adults. See advice on modification and duration of therapy vancomycin vancomycin vancomycin

PLUS

ceftriaxone 2 g intravenously, daily. See advice on modification and duration of therapy. ceftriaxone ceftriaxone ceftriaxone

For adults who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use vancomycin plus ceftriaxone as above.

For patients who have had a severe immediate¹ hypersensitivity reaction to a penicillin, vancomycin plus ceftriaxone (at the dosages above) can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).

For adults who have had a severe delayed² hypersensitivity reaction to a penicillin, seek expert advice.

¹ Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return

² Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return