What is the first-line antibiotic for a patient with a perforated viscus?

In the case of a perforated viscus, the primary concern is to address the potential for polymicrobial infection due to the presence of intestinal flora entering the peritoneal cavity. The correct choice of a first-line antibiotic involves coverage of both aerobic and anaerobic bacteria alongside potential resistant organisms.

A combination of piperacillin-tazobactam or a carbapenem is effective in this scenario because piperacillin-tazobactam provides broad-spectrum coverage, including gram-negative bacilli and anaerobes, which are prevalent in gastrointestinal flora. Carbapenems also offer broad-spectrum coverage and are particularly useful in cases where resistant organisms might be present. This is crucial in treating intra-abdominal infections resulting from a perforation.

While other options might offer some coverage, they generally do not provide the comprehensive protection needed for such a critical condition. Amoxicillin-clavulanate or tetracycline may not adequately address the range of bacteria involved in this type of infection. Ciprofloxacin with metronidazole does provide good coverage, particularly for anaerobes, but lacks the broad coverage needed for the diverse types of bacteria found in the gut. Vancomycin alone mainly targets gram-positive organisms and does not suffice for the anaer