Acute enteric sepsis: bacteriology and antibiotic cover

Most cases of enteric sepsis are caused by both aerobic and anaerobic organisms which form the normal flora of the mouth and lower gastrointestinal tract. This flora is extremely variable and subject to change due to disease and antimicrobial treatment. Bacteriological investigation of patients with severe enteric sepsis is important and should be undertaken before antibiotic treatment is commenced. The choice of antibiotics depends on the nature of the infection and its location. Initially they should be given in maximum dosage. If polymicrobial infection is suspected both aerobes and anaerobes should be covered to prevent bacteraemic shock and abscess formation. If abscesses have formed or the patient fails to respond to appropriate antibiotics, surgical exploration and drainage remain the treatment of choice. Antibiotics often fail to eradicate organisms from established abscesses and are responsible for some serious complications.