From the Guidelines
The patient should be started on empiric antibiotics immediately, given the elevated WBC count of 13,000 and the presence of ileus, which may indicate an underlying infectious process. The choice of empiric antimicrobial therapy depends on various factors, including the patient's history, clinical status, and local epidemiologic factors, as outlined in the Surviving Sepsis Campaign guidelines 1. A reasonable initial regimen would be a broad-spectrum antibiotic such as piperacillin-tazobactam 3.375g IV every 6 hours (dose adjusted for age and renal function if needed) or ceftriaxone 1g IV daily plus metronidazole 500mg IV every 8 hours.
- The elevated white blood cell count suggests an inflammatory or infectious process that may be causing or complicating the ileus.
- In elderly patients with leukocytosis, there's a significant risk of intra-abdominal infection, sepsis, or bowel ischemia that could rapidly deteriorate without antimicrobial coverage.
- Additional workup should include blood cultures, abdominal imaging, and close monitoring of vital signs and clinical status.
- Supportive care with IV fluids should continue, along with nasogastric decompression if appropriate.
- The antibiotic regimen can be de-escalated or discontinued based on culture results and clinical improvement, typically reassessing within 48-72 hours, as recommended by the guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Patient Assessment
- The patient is 81 years old with an ileus on IVF and a WBC count of 13, indicating a potential infection.
- The elevated WBC count suggests a possible bacterial infection, but the presence of an ileus may also be a contributing factor.
Antibiotic Treatment Considerations
- According to 2, broad-spectrum antimicrobials should be initiated within the first hour of diagnosis in suspicious or confirmed cases of sepsis.
- 3 also recommends immediate, empiric, broad-spectrum therapy for patients with severe sepsis and/or shock.
- However, 4 notes that one third of patients empirically treated with broad-spectrum antibiotics in the emergency department are ultimately diagnosed with noninfectious or viral conditions.
- 5 emphasizes the importance of getting the initial empirical therapy right, as inappropriate or inadequate initial therapy is associated with increased mortality, morbidity, and length of hospital stay.
Decision to Start Antibiotics
- Given the patient's age, elevated WBC count, and potential for sepsis, starting antibiotics may be justified.
- However, it is essential to consider the possibility of noninfectious or viral conditions, as noted in 4.
- A thorough evaluation of the patient's condition, including laboratory results and clinical presentation, is necessary to determine the likelihood of bacterial infection and the need for antibiotic treatment.