Modification and duration of therapy for severe postprocedural pelvic infection

Pharmacokinetics may be altered in patients who are critically ill (eg because of enhanced kidney clearance or changes in volume of distribution). To ensure adequate drug exposure in patients with severe postprocedural pelvic infection who have septic shock or require intensive care support, a modified dosage of ceftriaxone is recommended. Once the critical illness has resolved, consider switching to the standard dosage.

Modify therapy based on the results of culture and susceptibility testing.

If the results of susceptibility testing are not available by 72 hours after the initial empirical antibiotic dose, intravenous therapy is still required, and gentamicin or tobramycin was used initially, switch to the ceftriaxone plus metronidazole regimen (as above).

Switch to an oral antibiotic regimen once the patient is clinically stable and able to tolerate and absorb oral therapy – see Guidance for antimicrobial intravenous to oral switch. Oral therapy should be based on the results of culture and susceptibility testing. If the results of susceptibility testing are not available, see Empirical therapy for nonsevere postprocedural pelvic infection for oral regimens. A total treatment duration (intravenous + oral) of at least 14 days is recommended.