Antimicrobial Treatment of Intra-Abdominal Infections

Abstract

There have been several recent changes that influence the management of intra-abdominal infections. These changes include important developments in antibiotic resistance such as increases in pneumococcal resistance, emergence of multi-drug-resistant enterococcal isolates, and decreasing sensitivity of anaerobes and gram-negative rods. In addition there are new antibiotics such as piperacillin/tazobactam, and new antibiotic dosing regimens such as single daily dosing of aminoglycosides. In this article, we will review the therapeutic approach to intra-abdominal infections with special emphasis on the various forms of peritonitis, cholecystitis, cholangitis, and diverticulitis. Several new concepts about the treatment of enterococcus, the management of bacterial and fungal peritonitis, and the prevention of spontaneous bacterial peritonitis will also be reviewed. Specific recommendations for the management of the different infections including antibiotic doses and costs will be provided. Finally the role of invasive procedures in the management of some of the infections will be explored.

Effect of pentaglobin and piperacillin on survival in a rat model of faecal peritonitis: importance of intervention timings

“…Piperacillin is one of the derivatives of ampicillin having excellent antibacterial activity against a wide variety of gram‐negative bacteria. Piperacillin in combination with other antibiotics has been effectively used for the treatment of peritonitis in humans and experimental animals ( 16–18). Arguedas et al ( 19) observed that all the aerobic isolates from 60 patients with intra‐abdominal infections were susceptible to piperacillin/tazobactum, whereas 19 were resistant to piperacillin alone.…”

Antimicrobial Therapy for Acute Colonic Diverticulitis

“…Of note, most patients with penicillin allergies can be treated safely with this agent. A theoretical problem with aztreonam is that it induces beta-lactamase production; when exposed to this agent, bacteria may begin expressing the enzyme, which could make ultimate eradication of the infection more difficult [48].…”

Akutes Abdomen und Peritonitis: Pathophysiologie und Therapiekonzepte

“…Meistens finden sich in den Kulturen Escherichia coli und Bacteroides fragilis. Die antibiotische Therapie der diffusen Peritonitis muss deshalb primär aerobe gramnegative wie auch anaerobe Keime abdecken [29]. Es werden aber auch, in Abhängigkeit von der Quelle der Infektion, zwischen 30 und 70% grampositive Keime gefunden [30,31].…”

“…Im Gegensatz dazu zeigte eine Studie aus Großbritan-nien, dass bei intraabdominalen Infektionen, die nicht von einer Appendizitis ausgehen, eine antibiotische Therapie gewählt werden sollte, welche gegen Enterokokken wirksam ist [35]. Obwohl in bis zu 10% auch Pilze isoliert werden [32][33][34] [29,41,42]. Bei all diesen Über-legungen betreffs der Wahl der antibiotischen Therapie darf jedoch nicht vergessen werden, dass die zeitgerechte chirurgische Intervention das weitaus wichtigste Kriterium für das Resultat darstellt.…”