Biliary Infections
Severe/Hospital-acquired

Severe/Hospital-acquired

Recommended Empiric Regimens

Meropenem Use Criteria

Give meropenem for patients meeting ≥1 of the following risks:

  1. History of ESBL-organisms or other multi-drug resistant gram-negative organisms
  2. Treatment failure with broad-spectrum antibiotics
  3. Documented severe allergy that precludes use of cefepime and piperacillin/tazobactam

Enterococcal Coverage/Vancomycin Use Criteria

Empiric enterococcal coverage with vancomycin should only be considered in patients with the following risks:

  1. Immunosuppression
  2. Post-operative infection
  3. Broad-spectrum antibiotic exposure in the preceding 90 days
  4. Valvular heart disease and/or prosthetic intravascular devices

If enterococcal risk factors are present, consult pharmacy for vancomycin if not already prescribed a penicillin or carbapenem