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Antibiotics for Abdominal Infection


Intra-abdominal Infection

Antibiotic therapy for abdominal infection

Abdominal infections are treated by resuscitation, abdominal drainage, control of the source of infection, and antimicrobial agents. Ideally, antimicrobial therapy is active against expected pathogens, safe and effective in clinical trials, inexpensive, and unlikely to promote drug resistance. Numerous single-agent and combination-drug regimens have been efficacious in clinical trials, based on coverage of Escherichia coli and Bacteroides species, the predominant pathogens isolated.

Whether expanded antimicrobial coverage is required, especially in hospital-acquired infections, is controversial. Candida infections should be treated with antifungal therapy in patients with recurrent abdominal infections, immunosuppressed patients, and those with candidal abscesses. Most agents have few serious adverse effects; aminoglycosides are the least expensive agents but cause nephro- and ototoxicity.

There is little information on the promotion of drug resistance in this condition. Recent developments include the introduction of ticarcillin/clavulanic acid, ampicillin/ sulbactam, piperacillin/tazobactam, meropenem, aztreonam/clindamycin, and ciprofloxacin/metronidazole; success with once-daily aminoglycosides; evidence that antibiotics limit infectious complications of pancreatitis; controversy over the value of diagnostic cultures; the use of oral therapy; evidence in favor of shorter courses of treatment; and the introduction of pharmacoeconomic studies. Clinical investigators are challenged to improve drug trials by stratifying and controlling for the adequacy of surgical intervention.

High-risk intra-abdominal infection patients

Patient factors:
  • Old age
  • Malnutrition (low albumin level)
  • Preexisting medical conditions (esp. cardiovascular diseases)
  • High APACHE-II score
  • Disease factors:

  • Nosocomial origin of infection
  • Resistant pathogens
  • Lack of adequate source control
  • Antibiotics for high-risk intra-abdominal infection

    Single agent:
  • tieanm, mepem, tazocin
  • Combination agent:
  • aminoglycoside + anegyn, cipro + anegyn, 3rd cephalosporin + anegyn, aztreonam + clindamycin
  • (additional aminoglycoside is not beneficial)
  • (antifungal therapy is reasonable)
  • Duration of antibiotics treatment

    24 hours is recommended for these patients:
    1. traumatic or iatrogenic small intestine, colon perforation < 12 hrs
    2. gastroduodenal perforation < 24 hrs
    3. acute or gangrenous appendicitis without perforation
    4. acute or gangrenous cholecystitis without perforation
    5. transmural bowel necrosis from embolic, thrombotic or obstructive vascular occlusion without perforation, abscess, peritonitis
    agents: unasyn, cefoxitin, taxocin, timentin

    for other patients: 5 ~ 7 days antibiotics treatment
    if S/S beyond 7 days, diagnostic investigation rather than prolongation of antibiotic treatment
    if adequate source control cannot be done, a longer duration of antibiotic treatment

    note:

  • completion of antibiotic course by oral agents is acceptable. Cipro + flagyl, augmentin
  • once daily aminoglycoside with blood level monitor
  • intra-operative culture is not important for low risk patients
  • Intra-Abdominal Infection

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