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Treatment of intra-abdominal infections
1Department of Community Health and Medicine, Tufts University School of Medicine, Boston, MA 02111.
Abstract:
Intra-abdominal infections are caused by a mixture of aerobic, anaerobic and facultatively anaerobic bacteria. Experimental studies in animals and clinical trials indicate that antimicrobial therapy should provide adequate coverage for the whole range of isolates. Penicillins and cephalosporins with relatively limited activity against anaerobes have been associated with clinical failures in treating various types of mixed infections. Aminoglycosides are often used in combination with other drugs in the treatment of intra-abdominal infections. Recent studies have cast doubt on this practice because of increased resistance of Gram-negative bacilli to aminoglycosides and high rates of renal toxicity. Regimens that do not include an aminoglycoside have given good results in treatment of appendicitis, penetrating abdominal trauma, and peritonitis. Enterococci are frequently isolated from intra-abdominal infections, but evidence suggests that it is not necessary to direct treatment at this organism initially.
Insights
Antimicrobial therapy for intra-abdominal infections requires broad coverage. Omitting aminoglycosides may improve outcomes and reduce toxicity in treating these complex bacterial infections.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Intra-abdominal infections (IAIs) involve diverse aerobic, anaerobic, and facultative anaerobic bacteria.
- Effective antimicrobial therapy necessitates comprehensive coverage against a wide spectrum of potential pathogens.
- Previous treatment strategies often included penicillins, cephalosporins, and aminoglycosides.
Purpose of the Study:
- To evaluate the efficacy and safety of antimicrobial regimens for intra-abdominal infections.
- To assess the role of aminoglycosides in combination therapy for IAIs.
- To determine optimal antimicrobial strategies considering bacterial resistance and toxicity.
Main Methods:
- Review of experimental animal studies and clinical trials on antimicrobial therapy for IAIs.
- Analysis of treatment outcomes associated with different antibiotic classes, including penicillins, cephalosporins, and aminoglycosides.
- Evaluation of bacterial resistance patterns and drug-related toxicities, particularly renal toxicity.
Main Results:
- Penicillins and cephalosporins with limited anaerobic activity have been linked to treatment failures in mixed infections.
- Concerns exist regarding increasing Gram-negative bacilli resistance to aminoglycosides and their associated high rates of renal toxicity.
- Regimens excluding aminoglycosides have demonstrated favorable outcomes in treating appendicitis, penetrating abdominal trauma, and peritonitis.
Conclusions:
- Antimicrobial therapy for intra-abdominal infections should ensure broad-spectrum coverage.
- Aminoglycoside-containing regimens may not be necessary and can be associated with significant toxicity and resistance.
- Alternative treatment strategies, potentially omitting aminoglycosides, show promise for improved efficacy and safety in managing IAIs.