Anaerobic infection therapy

Anaerobes are involved mainly in abdominal surgical infections and the Bact eroides fragilis group is still predominant in such infections. By definiti on surgery itself plays the major role in therapy while antibiotics have an adjunctive role. Depending on the source of the infection, several combina tions of either an older cephalosporin for community acquired infections or a more advanced cephalosporin, an aminoglycoside, aztreonam or a quinolone with metronidazole or clindamycin for nosocomial infections, are acceptabl e therapeutic regimens. Cefoxitin, cefotetan, carbapenems and the: inhibito rs may also be used as monotherapy. However whenever selecting an antibioti c to combat anaerobes the following points should be seriously considered. The Value of anaerobic cultures which should always be obtained in order to be used for local resistance surveillance. There is a lack of important ne wer antimicrobials active against anaerobes. Studies of newer antibiotics g enerally exclude critically ill patients and are chiefly made up of appendi citis cases which by definition end up with > 90% cure rate. The importance of hyperbaric oxygen in selected cases should be considered. (C) 2000 Publ ished by Elsevier Science B.V. and International Society of Chemotherapy. A ll rights reserved.