An ongoing dialogue on HIV/AIDS, infectious diseases,
January 15th, 2014
Unanswerable Questions in Infectious Diseases: The Abdominal Collection and Duration of Antibiotic Therapy
Each time I attend on the inpatient service, the number of questions for which we just don’t have a definitive answer continues to amaze me. And here’s the most remarkable part — many of them come up all the time!
In that spirit, I will post a series of these quandaries, and you, the brilliant readers, will offer your answers or, barring a definitive answer, your individual approach.
Let’s start with this one:
How long should we continue antibiotics in someone with infected abdominal collection and a percutaneous drain?
You know the situation — peritonitis from perforation, or diverticular abscess, or a surgical mishap, and now the interventional radiologists have kindly placed a drain into the infected collection. (Or, more commonly, multiple drains into the multiple collections.) The patient, once critically ill, is improving — albeit slowly — and the resident, surgical PA, and surgeon all want to know the answer to the above question.
Low grade fevers — 99.5 F or so — continue. There might be an ongoing anastomotic leak, there might not. There is no plan for more surgery. White blood cell count is down from 25K to 15K. Platelets are slowly rising.
Yes, this is a specific variant on the age-old “How long should we treat?” question. I’ve opined on this before, but now we’re getting specific. These IDSA guidelines say “4-7 days,” but that implies rapid source control, no ongoing leak, everything going smoothly.
(And these smooth-sailing cases rarely trigger an ID consult.)
So what do you do in this particular situation? Please vote and comment — especially if you don’t like any of these answers!