Table 1.
Suggested Empirical Antibiotic Treatment for Nosocomial Bacterial Infections in Cirrhosis
| Type of Infection | Empirical Antibiotic Treatmenta |
|---|---|
| SBP or other spontaneous infections | Carbapenem (to cover ESBL‐producing Enterobacteriaceae) + a glycopeptide (to cover MRSA and VSE)b |
| Urinary infectionsc | Uncomplicated infections: nitrofurantoin (50 mg/6 hours by mouth) |
| Complicated infections (sepsis, severe sepsis, or shock): carbapenem + glycopeptideb | |
| Pneumoniac | Antibiotics active against Pseudomonas aeruginosa (i.e., meropenem or ceftazidime + ciprofloxacin) |
| A glucopeptide or linezolid should be added in patients with risk factors for MRSAd | |
| Cellulitis | Antibiotics active against Pseudomonas aeruginosa + glycopeptideb |
Abbreviation: ESBL, extended‐spectrum β‐lactamase.
a
Empirical antibiotic therapy should be adapted to the local epidemiological patterns of resistant bacteria.
b
In areas with a high prevalence of VRE, glycopeptides must be replaced with intravenous linezolid or daptomycin.
c
Nosocomial and HCA infections.
d
Ventilator‐associated pneumonia, previous antibiotic therapy, nasal MRSA carriage.