The treatment of the following patient should include:

e. Either a single agent or combination therapy is appropriate if the agents selected possess activity against both aerobic and anaerobic bacteria

The primary treatment for a perforated viscus is surgical, however antimicrobial therapy is an extremely important adjunct. Empiric antibiotic therapy for secondary bacterial peritonitis and intraabdominal abscess should be directed against both aerobes and anaerobes. Administration of an agent directed against only one component of the infection or the other is inferior to combined therapy. Several studies indicate that the results of using several agents in combination is equivalent to the use of a single agent therapy as long as the agents selected possess activity against both components of the infection. The addition of antientercoccal or antifungal agents as initial therapy has not been substantiated. The most beneficial duration of antibiotic therapy must be based on the setting for the specific patient. Minimal peritoneal contamination with adequate surgical treatment may be treated with a three-to five-day course of antibiotics, whereas longer periods are indicated for immunosuppressed patients and with patients with extensive contamination.