What is the recommended antibiotic lavage combination for a patient with recurrent intra-abdominal (intra-abdominal) abscesses?

From the FDA Drug Label

The clinical efficacy rates by pathogen are provided in Table 8

Table 8: Clinical Efficacy Rates by Pathogen for Clinically Evaluable Population

MICROORGANISMS1Meropenem for Injection n 2/N 3(%) 4Imipenem-cilastatin n 2/N 3(%) 4

Gram-positive aerobes

Staphylococcus aureus,methicillin susceptible 82/88 (93)84/100 (84)

Streptococcus pyogenes(Group A) 26/29 (90)28/32 (88)

Streptococcus agalactiae(Group B) 12/17 (71)16/19 (84)

Enterococcus faecalis9/12 (75)14/20 (70)

Viridans group streptococci11/12 (92)5/6 (83)

Gram-negative aerobes

Escherichia coli12/15 (80)15/21 (71)

Pseudomonas aeruginosa11/15 (73)13/15 (87)

Proteus mirabilis11/13 (85)6/7 (86)

Anaerobes

Bacteroides fragilis10/11 (91)9/10 (90)

Peptostreptococcus Species 10/13 (77)14/16 (88)

Antibiotic Lavage Combination Recommendation For a patient with recurrent intra-abdominal abscesses, a possible antibiotic combination could be meropenem (as seen in the provided drug label 1) due to its efficacy against various pathogens, including Gram-positive and Gram-negative aerobes and anaerobes. However, it's crucial to note that the choice of antibiotic should be based on the specific pathogens isolated from the patient's abscesses and their susceptibility patterns.

• Meropenem has shown effectiveness against a range of bacteria, including those commonly found in intra-abdominal infections.
• The provided drug label for piperacillin-tazobactam 2 also suggests its use in intra-abdominal infections, but the decision should be guided by the susceptibility of the causative organisms and the patient's clinical condition.

It's essential to consult with an infectious disease specialist or a clinical pharmacist to determine the most appropriate antibiotic regimen based on the patient's specific needs and the latest susceptibility data.

From the Research

For recurrent intraabdominal abscesses, I recommend a combination of normal saline with piperacillin-tazobactam for antibiotic lavage, as it has been shown to have high concentrations at the infection site and good efficacy in treating intraabdominal infections 3. This approach should be performed during surgical drainage procedures, with the solution allowed to dwell for 5-10 minutes before aspiration. The choice of antibiotic depends on the suspected pathogens, but piperacillin-tazobactam has been shown to be effective against a wide range of bacteria, including both aerobic and anaerobic bacteria. Some key points to consider when using antibiotic lavage for recurrent intraabdominal abscesses include:

• The importance of adequate surgical debridement, as antibiotics alone cannot effectively penetrate and treat abscesses
• The need for regular follow-up imaging to ensure resolution and detect early recurrence
• The potential for combining local antibiotic delivery with systemic antibiotic therapy based on culture results
• The importance of monitoring for worsening symptoms or recurrence and evaluating for underlying conditions that may have contributed to abscess formation 4 It's also worth noting that the size of the abscess can be critical to the effectiveness of each treatment, with smaller abscesses potentially being managed with antibiotics alone, and larger abscesses requiring drainage 5. However, the most recent and highest quality study suggests that piperacillin-tazobactam may have better efficacy compared to other antibiotics, such as imipenem or ertapenem 3.