Chapter 12 : Treatment of Intra-Abdominal Infections

Abstract:

Antibiotic therapy has assumed an increasingly important role in the management of intra-abdominal infections because of the replacement of surgical extirpation of inflamed and infected tissue by minimally invasive or percutaneous drainage procedures. This review describes the key findings of clinical trials performed to date and then describes settings in which antimicrobial agents may be the preferred antimicrobials. The organisms encountered in intra-abdominal infections are listed. Four quinolones have been examined in clinical trials for intra-abdominal infections: ciprofloxacin, trovafloxacin, clinafloxacin, and pefloxacin. These agents have considerable activity against the gram-negative facultative and aerobic organisms commonly encountered in intra-abdominal infections. The use of gentamicin as the sole agent with activity against aerobic gram-negative bacteria, however, may be probematic in intra-abdominal infections because anaerobic conditions may reduce its activity. Ciprofloxacin has little activity against Bacteroides fragilis and needs to be combined with an antianaerobic agent for empirical treatment of intra-abdominal infections. This study was designed to examine the efficacy of i.v. therapy and to explore conversion of therapeutic regimens to oral administration. The failure rates observed in general and with piperacillin-tazobactam (PIP/TAZO) in particular are markedly different from the other studies done with quinolones and the even larger number done with PIP/TAZO. The safety and efficacy of quinolone-based regimens in intra-abdominal infections has been clearly documented in clinical trials and is supported by the pharmacodynamics of these agents.