Summary
Anaerobic infections in man are most commonly caused by nonsporing organisms. Such organisms occur naturally as commensals in the oropharynx, the female genital tract and the large bowel — where they constitute the predominant flora. From their normal habitat these organisms may invade adjacent tissues which are debilitated or the seat of some pathological change.
With the appreciation of the clinical significance of anaerobic bacteria came the need for appropriate treatment. Many antimicrobial agents have been tried. Penicillin has been used with success in the treatment of orofacial sepsis and pleuropulmonary infection, but is inactive against Bacteroides fragilis which produces an effective β-lactamase. Tetracycline resistant organisms appear to have increased, and erythromycin has not found favour in the treatment of anaerobic sepsis. Chloramphenicol is active against almost all anaerobes, but its side effect as a bone marrow depressant must be borne in mind. Clindamycin is effective, but the possible development of pseudomembranous colitis must be considered. Metronidazole is at present used with success in a variety of anaerobic infections. The development of β-lactamase inhibiting agents, such as clavulanic acid, may indicate future trends in the chemotherapy of these infective conditions.
The antimicrobial agents currently in use for the treatment of anaerobic sepsis include penicillin, metronidazole, clindamycin, and cefoxitin, a modified form of a member of a new family of β-lactam antibiotics — the cephamycins.
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References
Barling, R.W.A. and Selkon, J.B.: The penetration of antibiotics into cerebrospinal fluid and brain tissue. Journal of Antimicrobial Chemotherapy 4: 203–227 (1978).
Bartlett, J.G.; Gorbach, S.L.; Tally, F.P. and Finegold, S.M.: Bacteriology and treatment of primary lung abscess. American Review of Respiratory Disease 109: 510–518 (1974).
Bartlett, J.G.; Sutter, V.L. and Finegold, S.M.: Treatment of anaerobic infections with lincomycin and clindamycin. New England Journal of Medicine 287: 1006–1010 (1972).
Birnbaum, J.; Stapley, E.O.; Miller, A.K.; Wallick, H.; Hendlin, D. and Woodruff, H.B.: Cefoxitin, a semi-synthetic cephamycin: A microbiological overview. Journal of Antimicrobial Chemotherapy 4(Suppl. B): 15–32 (1978).
Bodner, S.J.; Koenig, M.G. and Goodman, J.S.: Bacteremic Bacteroides infections. Annals of Internal Medicine 73: 537–544 (1970).
Brogden, R.N.; Heel, R.C; Speight, T.M. and Avery, G.S.: Metronidazole in anaerobic infections: A review of its activity, pharmacokinetics and therapeutic use. Drugs 16: 387–417 (1978).
Brogden, R.N.; Heel, R.C.; Speight, T.M. and Avery, G.S.: Cefoxitin: A review of its antibacterial activity, pharmacological properties and therapeutic use. Drugs 17: 1–37 (1979).
Busch, D.F.; Heseltine, P.N.R.; Meyer, R.D.; Sutter, V.L. and Finegold, S.M.: Cefoxitin sodium therapy of anaerobic infections. Journal of Antimicrobial Chemotherapy 4(Suppl. B): 197–202 (1978).
Chow, A.W.; Patten, V. and Guze, L.B.: Susceptibility of anaerobic bacteria to metronidazole: Relative resistance of non spore-forming gram positive bacilli. The Journal of Infectious Diseases 131: 182–185 (1975).
Editorial: Chemotherapy of brain abscess. Lancet 2: 1081–1082 (1978).
Editorial: Bacteroides in the blood. Lancet 1: 27–28 (1973).
Finch, R.G.; Phillips, A. and Geddes, A.M.: A clinical, microbiological and toxicological assessment of clindamycin phosphate. Journal of Antimicrobial Chemotherapy 1: 297–303 (1975).
Finegold, S.M.: Central nervous system infections; in Anaerobic Bacteria in Human Disease, pp. 155–181 (Academic Press, New York 1977).
Garfield, J.: Management of supratentorial intracranial abscess: A review of 200 cases. British Medical Journal 2: 7–11 (1969).
Garrod, L.P.: Sensitivity of four species of bacteroides to antibiotics. British Medical Journal 2: 1529–1531 (1955).
Garrod, L.P.; Lambert, H.P. and O’Grady, F.: in Antibiotic and Chemotherapy, p.208 (Churchill Livingstone, Edinburgh and London 1973).
Goldring, J.; Scott, A.; McNaught, W. and Gillespie, G.: Prophylactic oral antimicrobial agents in elective colonic surgery. Lancet 2: 997–1000 (1975).
Hamilton-Miller, J.M.T.: Antimicrobial agents acting against anaerobes. Journal of Antimicrobial Chemotherapy 1: 273–289 (1975).
Heineman, H.S. and Braude, A.I.: Anaerobic infection of the brain. American Journal of Medicine 35: 682–697 (1963).
Ingham, H.R.; Dutton, J.; Sisson, P.R.; Sprott, M.S. and Selkon, J.B.: An aid to the preliminary identification of non-sporing anaerobes. Journal of Clinical Pathology 31: 806–807 (1978a).
Ingham, H.R.; Eaton, S.; Venables, C.W. and Adams, P.C.: Bacteroides fragilis resistant to metronidazole after long term therapy. Lancet 1: 214 (1978b).
Ingham, H.R.; High, A.S.; Kalbag, R.M.; Sengupta, R.P.; Tharagonnet, D. and Selkon, J.B.: Abscesses of the frontal lobe of the brain secondary to covert dental sepsis. Lancet 2: 497–499 (1978c).
Ingham, H.R.; Hood, F.J.C.; Bradnum, P.; Tharagonnet, D. and Selkon, J.B.: Metronidazole compared with penicillin in the treatment of acute dental infections. British Journal of Oral Surgery 14: 264–269 (1977a).
Ingham, H.R.; Rich, G.E.; Selkon, J.B.; Hale, J.H.; Roxby, C.M.; Betty, M.J.; Johnson, R.W.C. and Uldall, P.R.: Treatment with metronidazole of three patients with serious infections due to Bacteroides fragilis. Journal of Antimicrobial Chemotherapy 1: 235–242 (1975a).
Ingham, H.R.; Selkon, J.B.; Codd, A.A. and Hale, J.H.: A study in vitro of the sensitivity to antibiotics of Bacteroides fragilis. Journal of Clinical Pathology 21: 432–436 (1968).
Ingham, H.R.; Selkon, J.B.; Codd, A.A. and Hale, J.H.: The effect of carbon dioxide on the sensitivity of Bacteroides fragilis to certain antibiotics in vitro. Journal of Clinical Pathology 23: 254–258 (1970).
Ingham, H.R.; Selkon, J.B. and Hale, J.H.: The antibacterial activity of metronidazole. Journal of Antimicrobial Chemotherapy 1: 355–361 (1975b).
Ingham, H.R.; Selkon, J.B. and Roxby, C.M.: Bacteriological study of otogenic cerebral abscesses: Chemotherapeutic role of metronidazole. British Medical Journal 2: 991–993 (1977b).
Ingham, H.R.; Selkon, J.B. and Roxby, C.M.: The bacteriology and chemotherapy of otogenic cerebral abscesses. Journal of Antimicrobial Chemotherapy 4(Suppl. C): 63–69 (1978d).
Ingham, H.R.; Sisson, P.R.; Tharagonnet, D.; Selkon, J.B. and Codd, A.A.: Inhibition of phagocytosis in vitro by obligate anaerobes. Lancet 2: 1252–1254 (1977c).
Ings, R.M.; McFadzean, J.A. and Omerod, W.E.: The mode of action of metronidazole in Trichomonas vaginalis and other micro-organisms. Biochemical Pharmacology 23: 1421–1429 (1974).
Keusch, G.T. and O’Connell, C.J.: The susceptibility of bacteroides to the penicillins and cephalothin. American Journal of Medical Science 251: 428–432 (1966).
Kosmidis, J.; Hamilton-Miller, J.M.T.; Gilchrist, J.N.G.; Kerry, D.W. and Brumfitt, W.: Cefoxitin, a new semi-synthetic cephamycin: An in vitro and in vivo comparison with cephalothin. British Medical Journal 4: 653–655 (1973).
Leading Article: Antibiotic associated colitis: A progress report. British Medical Journal 1: 669–671 (1978).
Leading Article: Lincomycin and clindamycin colitis. British Medical Journal 4: 65–66 (1974).
Leigh, D.A.: Clinical importance of infections due to Bacteroides fragilis and the role of antibiotic therapy. British Medical Journal 3: 225–228 (1974).
Louie, T.J.; Bartlett, J.G.; Onderdonk, A.B. and Gorbach, S.L.: Failure of chloramphenicol therapy of experimental intra-abdominal sepsis. Interscience Conference on Antimicrobial Agents and Chemotherapy, Abstract No. 25 (1977).
Nastro, L.J. and Finegold, S.M.: Bacterial activity of five antimicrobial agents against Bacteroides fragilis. Journal of Infectious Diseases 126: 104–107 (1972).
Roe, F.J.C.: Metronidazole: Review of uses and toxicity. Journal of Antimicrobial Chemotherapy 3: 205–212 (1977).
Shinn, D.L.S.: Metronidazole in acute ulcerative gingivitis. Lancet 1: 1191 (1962).
Squires, S.: Personal communication (1975).
Study Group: Metronidazole in the prevention and treatment of Bacteroides infections in gynaecological patients. Lancet 2: 1540–1543 (1974).
Sutter, V.L. and Finegold, S.M.: Susceptibility of anaerobic bacteria to carbenicillin, cefoxitin and related drugs. Journal of Infectious Diseases 131: 417–422 (1975).
Sutter, V.L.; Oberhammer, I.; Kwok, Y.-Y. and Finegold, S.M.: Susceptibility of anaerobes to cefoxitin sodium and cephalothin. Journal of Antimicrobial Chemotherapy 4(Suppl. B): 41–46 (1978).
Tally, F.P.: Treatment of anaerobic pleuropulmonary infection and preliminary evaluation of metronidazole. Metronidazole. Proceedings of the International Conference, Montreal, pp.341–346 (Excerpta Medica, Amsterdam 1977).
Tally, F.P.; Jacobus, N.V. and Gorbach, S.L.: In vitro activity of thienamycin. Antimicrobial Agents and Chemotherapy 14: 436–438 (1978).
Thadepalli, H. and Huang, J.T.: Treatment of anaerobic infections: Carbenicillin alone compared with clindamycin and gentamicin. Current Therapeutic Research 22: 549–555 (1977).
Thadepalli, H.; Webb, D.; Roy, I. and Bach, V.: Evaluation of cefoxitin sodium therapy in anaerobic infections. Journal of Antimicrobial Chemotherapy 4(Suppl. B): 203–208 (1978).
Ursing, B. and Kamme, C.: Metronidazole for Crohn’s disease. Lancet 1: 775–777 (1975).
Van Winzum, C: Clinical safety and tolerance of cefoxitin sodium: An overview. Journal of Antimicrobial Chemotherapy 4(Suppl. B): 91–104 (1978).
Whelan, J.P.F. and Hale, J.H.: Bactericidal activity of metronidazole against Bacteroides fragilis. Journal of Clinical Pathology 26: 393–395 (1975).
Willis, A.T.: The treatment of anaerobic bacterial infections. British Journal of Hospital Medicine 20: 579–585 (1978).
Willis, A.T.; Ferguson, I.R.; Jones, P.H.; Phillips, K.D.; Tearle, P.V.; Berry, R.B.; Fiddian, R.V.; Graham, D.F.; Harland, D.H.C.; Innes, D.B.; Mee, W.M.; Roth well-Jackson, R.L.; Sutch, I.; Kilbey, C. and Edwards, D.: Metronidazole in prevention and treatment of Bacteroides infections after appendicectomy. British Medical Journal 1: 318–321 (1976).
Willis, A.T.; Ferguson, I.R.; Jones, P.H.; Phillips, K.D.; Tearle, P.V.; Fiddian, R.V.; Graham, D.F.; Harland, D.H.C.; Hughes, D.F.R.; Knight, D.; Mee, W.M.; Pashby, N.; Roth-well-Jackson, R.L.; Sachdeva, A.K.; Sutch, I.; Kilby, C. and Edwards, D.: Metronidazole in prevention and treatment of Bacteroides infections in elective colonic surgery. British Medical Journal 1: 607–610 (1977).
Wust, J. and Wilkins, T.D.: Effect of clavulanic acid on anaerobic bacteria resistant to beta-lactam antibiotics. Antimicrobial Agents and Chemotherapy 13: 130–133 (1978).
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Sprott, M.S., Ingham, H.R. Treatment of Infections due to Nonsporing Anaerobes. Drugs 18, 137–149 (1979). https://doi.org/10.2165/00003495-197918020-00006
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DOI: https://doi.org/10.2165/00003495-197918020-00006