From the Guidelines
For ileus and skin infections, a good broad spectrum antibiotic choice would be piperacillin-tazobactam (Zosyn), typically dosed at 3.375g IV every 6 hours or 4.5g IV every 8 hours for adults with normal renal function. This recommendation is based on the most recent and highest quality study available, which suggests that piperacillin-tazobactam is effective against both gram-positive and gram-negative organisms, including those commonly causing skin infections and ileus-associated infections 1.
Alternative Options
Alternative options include meropenem (1g IV every 8 hours) or the combination of ceftriaxone (1-2g IV daily) plus metronidazole (500mg IV every 8 hours) 1. These antibiotics are effective because they cover a broad spectrum of bacteria, including gram-positive organisms like Staphylococcus and Streptococcus, and gram-negative and anaerobic bacteria that may be involved in ileus-associated infections.
Treatment Duration and Management
Treatment duration typically ranges from 5-14 days depending on infection severity and clinical response. It's essential to note that antibiotics alone may not resolve ileus, which often requires additional management, including:
- Bowel rest
- Nasogastric decompression
- Treating the underlying cause Cultures should be obtained before starting antibiotics when possible, and therapy should be narrowed based on culture results. Dose adjustments may be necessary for patients with renal impairment.
Importance of Cultures and Susceptibility Testing
Obtaining cultures and performing susceptibility testing are crucial in guiding antibiotic therapy, especially in cases where there is significant resistance to commonly used antibiotics 1. This helps in identifying the most effective antibiotic regimen and reducing the risk of antibiotic resistance.
Key Considerations
When selecting an antibiotic regimen, it's essential to consider local microbiologic data, cost, allergies, and formulary availability. Additionally, the use of broad-spectrum antibiotics should be judicious and reserved for cases where they are truly necessary, to minimize the risk of promoting antibiotic resistance.
From the FDA Drug Label
- 1 Intra-abdominal Infections Piperacillin and Tazobactam for Injection is indicated in adults and pediatric patients (2 months of age and older) for the treatment of appendicitis (complicated by rupture or abscess) and peritonitis caused by beta-lactamase producing isolates of Escherichia coli or the following members of the Bacteroides fragilis group: B. fragilis, B. ovatus, B. thetaiotaomicron, or B. vulgatus.
- 3 Skin and Skin Structure Infections Piperacillin and Tazobactam for Injection is indicated in adults for the treatment of uncomplicated and complicated skin and skin structure infections, including cellulitis, cutaneous abscesses and ischemic/diabetic foot infections caused by beta-lactamase producing isolates of Staphylococcus aureus.
- 2 Complicated Intra-abdominal Infections (Adult and Pediatric Patients) Meropenem for injection is indicated for the treatment of complicated appendicitis and peritonitis caused by viridans group streptococci, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides fragilis, B. thetaiotaomicron,and Peptostreptococcusspecies.
- 1 Complicated Skin and Skin Structure Infections (Adult Patients and Pediatric Patients 3 Months of Age and Older Only) Meropenem for injection is indicated for the treatment of complicated skin and skin structure infections (cSSSI) due to Staphylococcus aureus(methicillin-susceptible isolates only), Streptococcus pyogenes, Streptococcus agalactiae, viridans group streptococci, Enterococcus faecalis(vancomycin-susceptible isolates only), Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis,Bacteroides fragilis,and Peptostreptococcusspecies.
Broad-spectrum antibiotics for ileus and skin infection are:
- Piperacillin-tazobactam (2)
- Meropenem (3) Key points:
- Piperacillin-tazobactam is effective against beta-lactamase producing isolates of Escherichia coli and Bacteroides fragilis group.
- Meropenem is effective against a broad range of bacteria, including Pseudomonas aeruginosa, Escherichia coli, and Bacteroides fragilis.
From the Research
Broad Spectrum Antibiotics for Ileus and Skin Infection
- Piperacillin/tazobactam is a broad-spectrum antibiotic that has been shown to be effective in treating various infections, including intra-abdominal infections and skin/soft tissue infections 4, 5, 6.
- It has a broad spectrum of antibacterial activity, encompassing most Gram-positive and Gram-negative aerobic bacteria and anaerobic bacteria, including many pathogens producing beta-lactamases 4.
- Piperacillin/tazobactam has been compared to other antibiotics, such as imipenem/cilastatin, ceftazidime, and ticarcillin/clavulanic acid, and has been shown to be at least as effective, if not more effective, in treating certain infections 4, 7, 8.
- The antibiotic has been shown to be effective in treating complicated skin and soft tissue infections, and is considered a standard treatment for these types of infections 6.
- Piperacillin/tazobactam has also been shown to be cost-effective, with lower total medical costs and higher clinical success rates compared to other antibiotics in certain infections 8.
Specific Infections
- For ileus, piperacillin/tazobactam may be a good option due to its broad-spectrum activity and effectiveness in treating intra-abdominal infections 4, 5.
- For skin infections, piperacillin/tazobactam has been shown to be effective in treating complicated skin and soft tissue infections, and is considered a standard treatment for these types of infections 7, 6.
- The choice of antibiotic should always be based on the specific infection, the causative organism, and the patient's individual needs and medical history 6, 8.