BACTERIOLOGICAL AND THERAPEUTIC CONSIDERATIONS IN INTRAABDOMINAL SURGICAL INFECTIONS

The most important factor in the treatment of intra-abdominal infectio ns are early diagnosis and prompt surgical intervention while antibiot ics play a secondary role. The goals of surgical procedures should be to stop peritoneal contamination, to debride necrotic tissue, to remov e debris and foreign bodies and to drain any pus collection. Antibioti cs should be initiated before surgery and they must encompass both col onic aerobes and anaerobes including Bacteroides fragilis group but no t necessary Enterococcus sp. Antibacterial agents with pure activity a gainst anaerobes include chloramphenicol, clindamycin and the nitroimi dazoles while ampicillin/sulbactam, amoxicillin/clavulanate, ticarcill in/clavulanate, cefoxitin, cefotetan, ceftizoxime imipenem/cilastatin, meropenem and some advanced quinolones Like sparfloxacin, represent a single drug to cover both aerobic and anaerobic microflora. Although almost all clinical trials usually result in a 90% efficacy rate, the final outcome is dependant on the stage of the infection (early versus late), sepsis score, underlying diseases and the applied surgical pro cedures. On the other hand the choice of antibiotic(s) must be influen ced by its toxicity, profile, local nosocomial susceptibility patterns , resistance inducing ability and price. (C) 1997 Academic Press.