Skip to main content

Advertisement

SpringerLink
Log in

New developments and concepts in antimicrobial therapy for intra-abdominal infections

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Antimicrobial therapy plays an integral role in the management of intra-abdominal infections. Recent developments include increased prevalence of antimicrobial resistance (eg, Streptococcus pneumoniae and Enterococcus species) coupled with general decline in the antimicrobial susceptibility of anaerobes and gram-negative organisms, new antibiotics and dosing regimens, and better understanding of the role of various microbial pathogens and of prophylactic antimicrobial agents. Therapeutic approaches to intra-abdominal infections, such as the various forms of peritonitis, cholecystitis, cholangitis, and diverticulitis, are reviewed here. Specific recommendations for antimicrobial therapy in various clinical settings are provided, with special emphasis on recent trends and developments that reflect changes in understanding or therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Walker AP, Krepel CJ, Gohr CM, Edminston CE: Microflora of abdominal sepsis by locus of infection. J Clin Microbiol 1994, 32:557–558.

    PubMed  CAS  Google Scholar 

  2. Heseltine PNR, Yellin AE, Appleman MA, et al.: Perforated and gangrenous appendicitis: an analysis of antibiotic failures. J Infect Dis 1983, 148:322–329.

    PubMed  CAS  Google Scholar 

  3. Weinstein WM, Onderdonk AB, Bartlett JG, et al.: Antimicrobial therapy in experimental intraabdominal sepsis. J Infect Dis 1975, 32:282–286.

    Google Scholar 

  4. Rotstein OD, Pruett TL, Simmons RL. Microbiologic features and treatment of persistent peritonitis in patients in the intensive care unit. Can J Surg 1986, 29:247–250.

    PubMed  CAS  Google Scholar 

  5. Drug-resistant Streptococcus pneumoniae: Kentucky and Tennessee, 1993. Morb Mortal Wkly Rep 1994, 43:23–25.

  6. Wexler HM, Fingold SM. In vitro activity of cefotetan compared with other antimicrobial agents against anaerobic bacteria. Antimicrob Agents Chemother 1988, 32:601–604.

    PubMed  CAS  Google Scholar 

  7. Bourgault AM, Lamothe F, Hoban DJ, et al.: Survey of Bacteroides fragilis group susceptibility patterns in Canada. Antimicrob Agents Chemother 1992, 36:343–347.

    PubMed  CAS  Google Scholar 

  8. Payne JD, Cramp R, Winstanley DJ, et al.: Comparative activities of clavulonic acid, sulbactam, and tazobactam against clinically important b-lactamases. Antimicrob Agents Chemother 1994, 38:767–772.

    PubMed  CAS  Google Scholar 

  9. Sapico FL, Canawati HN, Glnunas VJ, et al.: Enterococci highly resistant to penicillin and ampicillin: an emerging clinical problem? J Clin Microbiol 1989, 27:2091–2095.

    PubMed  CAS  Google Scholar 

  10. Leclerq R, Dutka-Malen S, Brisson-Noel A, et al.: Resistance of enterococci to aminoglycosides and glycopeptides. Clin Infect Dis 1992, 15:495–501.

    Google Scholar 

  11. Acar J, Cassell GH, Cohen ML, et al.: Multiple antibiotic resistant pathogenic bacteria. N Engl J Med 1994, 330:1247–1251. This special report summarizes the global spread of antimicrobial resistance for many pathogens.

    Article  Google Scholar 

  12. Moellering RC, Linden PK, Reinhardt J, et al.: The efficacy and safety of quinupristin/dalfopristin for the treatment of infections caused by vancomycin-resistant Enterococcus faecium. J Antimicrob Chemother 1999, 44:251–261.

    Article  PubMed  CAS  Google Scholar 

  13. Sen S, Lalitha MK, Fenn AS, Mammen KE: Primary peritonitis in children. Ann Trop Paediatr 1983, 3:53–56.

    PubMed  CAS  Google Scholar 

  14. Runyon BA, Hoefs JC: Culture-negative neutrocytic ascites: a variant of spontaneous bacterial peritonitis. Hepatology 1984, 4:1209–1211.

    Article  PubMed  CAS  Google Scholar 

  15. Runyon BA: Monobacterial nonneutrocytic bacterascites: a variant of spontaneous bacterial peritonitis. Hepatology 1990, 12:710–715.

    Article  PubMed  CAS  Google Scholar 

  16. Wilcox CM, Dismukes WE: Spontaneous bacterial peritonitis: a review of pathogenesis, diagnosis, and treatment. Medicine 1987, 66:447–456.

    Article  PubMed  CAS  Google Scholar 

  17. Wosmer GP, Hubbard RC: Peritonitis in cirrhotic patients with Le Veen shunts. Am J Med 1981, 71:358–362.

    Article  Google Scholar 

  18. Runyon BA, McHutchinson JG, Antillon MR, et al.: Short course versus long course antibiotic treatment of SBP: a randomized controlled study of 100 patients. Gastroenterology 1991, 100:1737–1742.

    PubMed  CAS  Google Scholar 

  19. Navasa M, Follo A, Llovet JM, et al.: Randomized, comparative study of oral ofloxacin versus intravenous cefotaxime in spontaneous bacterial peritonitis. Gastroenterology 1996, 111:1011–1017. Results from this reported study indicate that oral ofloxacin is a reasonable alternative for patients with spontaneous bacterial peritonitis without overt sepsis, azotemia, or encephalopathy.

    Article  PubMed  CAS  Google Scholar 

  20. Runyon BA, Antillon MR, McHutchinson JG, et al.: Diuresis increases ascitic fluid opsonic activity in patients who survive spontaneous bacterial peritonitis. J Hepatol 1992, 14:249–252.

    Article  PubMed  CAS  Google Scholar 

  21. Soriano G, Guarner C, Teixido M, et al.: Selective intestinal decontamination prevents spontaneous bacterial peritonitis. Gastroenterology 1991, 100:477–481.

    PubMed  CAS  Google Scholar 

  22. Singh N, Gayowski T, Yu VL, et al.: Trimethoprim-sulfamethoxazole for the prevention of spontaneous bacterial peritonitis in cirrhosis: a randomized trial. Ann Intern Med 1995, 122:595–598.

    PubMed  CAS  Google Scholar 

  23. Dupeyron C, Mangeney N, Sedraty L, et al.: Rapid emergence of quinolone resistance in cirrhotic patients treated with norfloxacin to prevent spontaneous bacterial peritonitis. Antimicrob Agents Chemother 1994, 38:340–344.

    PubMed  CAS  Google Scholar 

  24. Nichols RL, Musik AC: Enterococcal infections in surgical patients: the mystery continues. Clin Infect Dis 1992, 15:72–76.

    PubMed  CAS  Google Scholar 

  25. More RD, Lietman PS, Smith CR: Clinical response to aminoglycoside therapy: importance of the ratio of concentration to minimal inhibitory concentration. J Infect Dis 1987, 155:93–99.

    Google Scholar 

  26. Craig WA, Vogelman B: The postantibiotic effect. Ann Intern Med 1987, 106:900–902.

    PubMed  CAS  Google Scholar 

  27. Luke M, Iversen J, Sondergard J, et al.: Ceftriaxone/metronidazole is more effective than amp/netilmicin/metronidazole in the treatment of bacterial peritonitis. Eur J Surg 1991, 157:397–401.

    PubMed  CAS  Google Scholar 

  28. Barie PS, Vogel SB, Dellinger EP, et al.: A randomized, doubleblind clinical trial comparing cefepime plus metronidazole with imipenem-cilastatin in the treatment of complicated intra-abdominal infections. Arch Surg 1997, 132:1294–1302.

    PubMed  CAS  Google Scholar 

  29. Williams R, Hotchin D: Aztreonam plus clindamycin versus tobramycin plus clindamycin in the treatment of intraabdominal infections. Rev Infect Dis 1991, 13:S629-S633.

    PubMed  Google Scholar 

  30. Birolini D, Moares MF, de Souza OS: Comparison of aztreonam plus clindamycin with tobramycin plus clindamycin in the treatment of intra-abdominal infections. Chemotherapy 1989, 35:S49-S57.

    Article  Google Scholar 

  31. Alvarez JS, Sacristan JA, Garcia IS, et al.: Immediate hypersensitivity to aztreonam. Lancet 1990, 335:1094.

    Article  Google Scholar 

  32. Solomkin JS, Reinhart HH, Dellinger EP, et al.: Results of a randomized trial comparing sequential intravenous/oral treatment with ciprofloxacin plus metronidazole to imipenem/cilastatin for intra-abdominal infections. Ann Surg 1996, 223:303–315.

    Article  PubMed  CAS  Google Scholar 

  33. Dougherty SH, Sirinek KR, Schauer PR, et al.: Ticarcillin/ clavulonate compared with clindamycin/gentamicin (with or without ampicillin) for the treatment of intraabdominal infections in pediatric and adult patients. Am Surg 1995, 61:297–303.

    PubMed  CAS  Google Scholar 

  34. Jaccard C, Troillet N, Harbarth S, et al.: Prospective randomized comparison of imipenem-cilastatin and piperacillintazobactam in nosocomial pneumonia or peritonitis. Antimicrob Agents Chemother 1998, 42:2966–2972. Both imipenem/cilastatin and piperacillin/tazobactam have a high success rate as single agents in treatment of patients with peritonitis, according to this report.

    PubMed  CAS  Google Scholar 

  35. Solomkin JS, Dellinger EP, Christou NV, et al.: Results of a multicenter trial comparing imipenem/cilastatin to tobramycin/ clindamycin for intra-abdominal infections. Ann Surg 1990, 212:581–591.

    Article  PubMed  CAS  Google Scholar 

  36. Wilson SE: Results of a randomized, multicenter trial of meropenem versus clindamycin/tobramycin for the treatment of intra-abdominal infections. Clin Infect Dis 1997, 24:S197-S206.

    PubMed  CAS  Google Scholar 

  37. Vas SI: Microbiologic aspects of chronic ambulatory peritoneal dialysis. Kidney Int 1983, 23:83–92.

    PubMed  CAS  Google Scholar 

  38. Pitt HA, Postier RG, Cameron JL: Biliary bacteria: significance and alterations after antibiotic therapy. Arch Surg 1982, 117:445–449.

    PubMed  CAS  Google Scholar 

  39. Shimada K, Inamatsu T, Yamashiro M: Anaerobic bacteria in biliary disease in elderly patients. J Infect Dis 1977, 135:850–854.

    PubMed  CAS  Google Scholar 

  40. Thompson JE: Broad-spectrum penicillin as adequate therapy for acute cholangitis. Surg Gynecol Obstet 1990, 171:275–282.

    PubMed  Google Scholar 

  41. Ball CS, Manson JM, Reid F, Tweedle DE: The pharmacokinetics of biliary excretion of ciprofloxacin. HPB Surg 1989, 1:319–326.

    PubMed  CAS  Google Scholar 

  42. Desai TK, Tsang TK: Aminoglycoside nephrotoxicity in obstructive jaundice. Am J Med 1988, 85:47–50.

    Article  PubMed  CAS  Google Scholar 

  43. Lai ECS, Mok FPT, Tan ESY, et al.: Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med 1992, 326:1582–1586.

    Article  PubMed  CAS  Google Scholar 

  44. Horner JL: Natural history of diverticulosis of the colon. Am J Dig Dis 1958, 3:343–350.

    Article  PubMed  CAS  Google Scholar 

  45. Freischlag J, Bennion RS, Thompson JE Jr: Complications of diverticular disease of the colon in young people. Dis Colon Rectum 1986, 29:639–643.

    Article  PubMed  CAS  Google Scholar 

  46. Bohnen JM, Solomkin JS, Dellinger EP, et al.: Guidelines for clinical care: anti-infective agents for intra-abdominal infection. Arch Surg 1992, 127:83–89.

    PubMed  CAS  Google Scholar 

  47. Schechter S, Mulvey J, Eisenstat T: Management of uncomplicated acute diverticulitis: results of a survey. Dis Colon Rectum 1999, 42:470–476. This survey of colorectal surgeons yielded several important findings. Most respondents reported that they treat patients with mild diverticulitis as outpatients, and a wide variation was seen in the choice of oral and intravenous regimens. The oral regimen used most often was a ciprofloxacin/metronidazole combination. The intravenous regimen used most was single coverage with either a secondgeneration cephalosporin or ampicillin/sulbactam.

    Article  PubMed  CAS  Google Scholar 

  48. Kellum JM, Sugerman HJ, Coppa GF, et al.: Randomized, prospective comparison of cefoxitin and gentamicinclindamycin combination in the treatment of acute colonic diverticulitis. Clin Ther 1992, 14:376–384.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Digestive Diseases, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, 21224, Baltimore, MD, USA

    Ziad Younes MD

  2. Division of Gastroenterology, Eastern Virginia Medical School, Norfolk, VA, USA

    David A. Johnson MD

Authors
  1. Ziad Younes MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David A. Johnson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Younes, Z., Johnson, D.A. New developments and concepts in antimicrobial therapy for intra-abdominal infections. Curr Gastroenterol Rep 2, 277–282 (2000). https://doi.org/10.1007/s11894-000-0019-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-000-0019-7

Keywords

Search

Navigation