Intra-abdominal infections

The natural and semi ynthetic penicillins are used in tire treatment of bacterial infections due to susceptible microorganisms. Fbnicillins may be used to treat infections such as urinary tract infections, septicemia, meningitis, intra-abdominal infection, gonorrhea, syphilis, pneumonia, and other respiratory infections. Examples of infectious microorganisms (bacteria) that may respond to penicillin therapy include gonococci, staphylococci,... 

Meropenem (Merrem IV) inhibits syndiesis of die bacterial cell wall and causes die deadi of susceptible cells. This drug is used for intra-abdominal infections caused by Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and odier susceptible organisms Meropenem also is effective against bacterial meningitis caused by Neisseria meningitidis, Streptococcus pneumoniae, and Hemophilus influenzae. 

Enterococcus species are normal inhabitants of the gastrointestinal tract, but should empiric treatment of intra-abdominal infections have activity against Enterococcus species Empiric treatment that covered Enterococcus species in intraabdominal infections was equivalent to empiric treatment that lacked enterococcal coverage. Routine coverage for Enterococcus is not necessary for patients with community-acquired intra-abdominal infections. However, in patients with nosocomial or high-severity infections, enterococcal coverage may be warranted.39... 

E. coli can also cause acute bacterial meningitis, pneumonia, intra-abdominal infections, enteric infections, urinary tract infections, septic arthritis, endophthalmitis, suppurative thyroiditis, sinusitis, osteomyelits, endocarditis, and skin and soft tissue infections. 

Signs and Symptoms Depend on the site of infection. Infection may produce osteomyelitis or arthritis pneumonia [with chills, productive cough, low blood pressure (hypotension), difficulty breathing (dyspnea), or chest pain] meningitis or cerebral abscesses (with headache, fever, vomiting, stupor, coma) or intra-abdominal infections (with biliary drainage, hepatic abscess, pancreatic abscess, peritoneal exudate). 

U.S. Eood and Drug Administration (FDA) Press release October 17,2007. FDA approves new drug to treat complicated urinary tract and intra-abdominal infections. Available at http //www.fda.gov/ (accessed on 14.12.2010). 

The safety and efficacy of ampicillin/sulbactam sodium has not been established for pediatric patients for intra-abdominal infections. CARBENICILLININDANYL SODIUM ... 

Bacterial septicemia, respiratory tract infections, skin and soft tissue infections, intra-abdominal Infections and infections of the female pelvis and genital tract... 

Complicated intra-abdominal infections (used in combination with metronidazole) caused by E. coli, viridans group streptococci, P. aeruginosa, K. pneumoniae, Enterobacter spec es, or Bacteroides fragilis. 

Serious gynecological and intra-abdominal infections 2glV q 8 h... 

Intra-abdominal infections Complicated appendicitis and peritonitis caused by viridans group streptococci, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacterioides fragilis, Bacterioides thetaiotaomicron, and Peptostreptococcus sp. 

Use in pediatric patients For pediatric patients 3 months of age and older, the meropenem dose is 20 or 40 mg/kg every 8 hours (maximum dose, 2 g every 8 hours), depending on the type of infection (intra-abdominal or meningitis). Administer pediatric patients weighing more than 50 kg 1 g every 8 hours for intra-abdominal infections and 2 g every 8 hours for meningitis. Give over approximately 15 to 30 minutes or as an IV bolus injection (5 to 20 ml) over approximately 3 to 5 minutes. 

Intra-abdominal Infections - Enterococcus faecalis, S. aureus (penicillinase-producing), Staphylococcus epidermidis, E. coli, Klebsiella sp., Enterobacter sp., Proteus sp., M. morganii, P. aeruginosa, Citrobactersp., Clostridium sp., Bacteroides sp. including Bacteroides fragilis, Fusobacterium sp. Peptococcus sp., Peptostreptococcus sp., Eubacterium sp., Proplonibacterium sp.. Bifidobacterium sp. 

Anaerobes Serious respiratory tract infections such as empyema, anaerobic pneumonitis, and lung abscess serious skin and soft tissue infections septicemia, intra-abdominal infections such as peritonitis and intra-abdominal abscess (typically resulting from anaerobic organisms resident in the normal Gl tract) infections of the female pelvis and genital tract such as endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff infection. 

Prompt diagnosis of intra-abdominal infections or of abscess formation elsewhere in the body by liberal use of ultrasound and other imaging techniques should lead to subsequent surgical treatment without delay. Soft tissue infections (superficial and deep) can have a dramatic clinical course. Timely diagnostic imaging and surgical treatment will equally reduce morbidity and mortality. 

Although the need for surgical intervention distinguishes most intra-abdominal infections from non-surgical infections, antimicrobial agents also play a major role in controlling sepsis and limiting the extent of dissemination of the infection in abdominal sepsis. In clinically stable patients without... 

Broad spectrum therapy is started on an empirical basis. Intra-abdominal infections can be treated by ampicillin (or amoxycillin) or clindamycin combined with aminoglycosides, penicillin-beta-lacta-mase inhibitors such as amoxycillin-clavulanic acid or a second or third generation cephalosporin combined with metronidazole are good alternatives. In patients with impaired immunity and/or prior use of antibiotics, i.e. when it is reasonable to expect resistant pathogens, a broad spectrum penicillin plus beta-lactamase inhibitor or a carbapenem can be used empirically in monotherapy. In septic patients, the rapidly bactericidal action of aminoglycosides is useful. Aminoglycosides should preferentially not be given for more than 3-5 days. 

Lowe MN and Lamb HM. Meropenem An updated review of its use in the management of intra-abdominal infections. Drugs 2000 60 619-646. 

Meningitis, serious gynecologic and intra-abdominal infections IV, IM 2g q 12h. Dosage in renal impairment After an initial I -g dose, dosage and frequency are modified based on creatinine clearance and the severity of f he infection. 

Mild, moderate, or severe infections of the Biliary, respiratory, and GU tracts skin. Bone, and intra-aBdominal infections meningitis and septicemia IV, IM 1 -2g q8-12h Life-threatening infections of the Biliary, respiratory, and GU tracts skin. Bone and intra-aBdominal infections meningitis and septicemia IV 3-4g q8h, up to 2g q4h Uncomplicated gonorrhea IM Ig one time. 

The indications for penidllin-3-lactamase inhibitor combinations are empirical therapy for infections caused by a wide range of potential pathogens in both immunocompromised and immunocompetent patients and treatment of mixed aerobic and anaerobic infections, such as intra-abdominal infections. Doses are the same as those used for the single agents except that the recommended dosage of piperacillin in the piperacillin-tazobactam combination is 3 g every 6 hours. Adjustments for renal insufficiency are made based on the penicillin component. 

Metronidazole is indicated for treatment of anaerobic or mixed intra-abdominal infections, vaginitis (trichomonas infection, bacterial vaginosis), C difficile colitis, and brain abscess. The typical dosage is 500 mg three times daily orally or intravenously (30 mg/kg/d). Vaginitis may respond to a single 2-g dose. A vaginal gel is available for topical use. 

Indications Lower respiratory infection Bone and joint infection Skin and skin structure infection Urinary tract infection Infectious diarrhea Acute sinusitis Prostatitis Typhoid fever Complicated intra-abdominal infection Gonorrhea... 

Intra-abdominal infection Meningitis (cryptococcal, fungal)... 

Tellado JM, Wilson SE. Empiric treatment of nosocomial intra-abdominal infections a focus on the car-bapenems. Surg Infect. 2005 6 329-343. 

Jiang, J., Xie, G., Liu, D., Zhu, P., Wang, Z., He, Y., Zhou, J., Xu, H. Effect of bactericidal /permeability-increasing protein on sepsis induced by intra-abdominal infection in rats. Chin J Traumatol 2 (1999a) 84-86. 

Moxifloxacin is more effective against anaerobes than ciprofloxacin or sparflox-acin, but has approximately the same activity as clindamycin (Tab. 14.8). In 2005 it was approved by the FDA as the first quinolone for the treatment of complicated intra-abdominal infections. 

Cefoxitin Cefotetan Mefoxin Cefotan IV, IM Perioperative prophylaxis in abdominal surgery, treatment of intra-abdominal infections, urinary tract infections, gynecological infections, septicemia, bone and joint infections, skin infections, lower respiratory infections... 

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