In 2010 the American Surgical Society and American Society of
Infectious Diseases have updated their guidelines for the treatment of abdominal infection.
The recommendations suggest the following:
For mild-to-moderate
community-acquired infections in adults, the agents recommended for empiric
regimens are: ticarcillin- clavulanate, cefoxitin, ertapenem, moxifloxacin, or
tigecycline as single-agent therapy or combinations of metronidazole with
cefazolin, cefuroxime, ceftriaxone, cefotaxime, levofloxacin, or ciprofloxacin.
Agents no longer recommended are: cefotetan and clindamycin ( Bacteroides
fragilis group resistance) and ampicillin-sulbactam (E. coli resistance)
and aminoglycosides (toxicity).
For high
risk community-acquired
infections in adults, the agents recommended for empiric regimens are:
meropenem, imipenem-cilastatin, doripenem, piperacillin-tazobactam,
ciprofloxacin or levofloxacin in combination with metronidazole, or ceftazidime
or cefepime in combination with metronidazole. Quinolones should not be used
unless hospital surveys indicate >90% susceptibility of E. coli to quinolones.
Aztreonam plus metronidazole is an alternative, but addition of an
agent effective against gram-positive cocci is recommended. The routine use of
an aminoglycoside or another second agent effective against gram-negative
facultative and aerobic bacilli is not recommended in the absence of evidence
that the infection is caused by resistant organisms that require such therapy.
Empiric use of agents effective against enterococci is recommended
and agents effective against methicillin-resistant S. aureus (MRSA )
or yeast is not recommended in the absence of evidence of infection due to such
organisms.
Empiric antibiotic therapy for health
care-associated intra-abdominal infection should
be driven by local microbiologic results. Empiric coverage of likely pathogens
may require multidrug regimens that include agents with expanded spectra of
activity against gram-negative aerobic and facultative bacilli. These include
meropenem, imipenem-cilastatin, doripenem, piperacillin-tazobactam, or
ceftazidime or cefepime in combination with metronidazole. Aminoglycosides or
colistin may be required.
Antimicrobial regimens for children include an aminoglycoside-based regimen, a carbapenem (imipenem, meropenem, or ertapenem), a beta-lactam/beta-lactamase-inhibitor combination (piperacillin-tazobactam or ticarcillin-clavulanate), or an advanced-generation cephalosporin (cefotaxime, ceftriaxone, ceftazidime, or cefepime) with metronidazole.
