Management of anaerobic infections

Successful management of anaerobic infection first requires an accurate diagnosis. Cytologic examination of wound exudates and inspection for characteristic clinical clues greatly facilitates an accurate initial diagnosis of anaerobic infection. Knowledge of antimicrobial activity against specific anaerobic pathogens is essential, since antibiotic susceptibility information is not routinely available. Whenever possible, antimicrobial and surgical therapy should be combined in managing anaerobic infections. Chloramphenicol, clindamycin, and metronidazole provide the most consistently reliable activity against pathogenic anaerobes, including Bacteroides. Penicillins are also generally effective, except for treatment of infections caused by penicillinase-producing strains of Bacteroides. Cephalosporins are not considered drugs of choice for anaerobic infections, although cefoxitin may in some instances be useful as monotherapy of mixed infections containing obligate anaerobes and coliform bacteria. Aminoglycosides and sulfonamides are ineffective and should be avoided for treatment of anaerobic infection.