What is the treatment for a 2 cm intra-abdominal abscess in psoriatic arthritis (PsA) with leukocytosis?

From the Guidelines

The treatment for a 2 cm intra-abdominal abscess in a patient with psoriatic arthritis and elevated leukocyte count typically requires a combination of percutaneous drainage and antibiotic therapy. The abscess should be drained via image-guided percutaneous catheter placement by interventional radiology, as this 2 cm collection is large enough to warrant drainage but small enough to avoid open surgical intervention in most cases. Empiric broad-spectrum antibiotic therapy should be initiated immediately, typically with combinations such as piperacillin-tazobactam 4.5g IV every 6 hours or meropenem 1g IV every 8 hours, plus metronidazole 500mg IV every 8 hours if anaerobic coverage is needed, as recommended by recent guidelines 1. Antibiotic therapy should be adjusted based on culture and sensitivity results from the drained fluid, and continued for 7-14 days depending on clinical response. The patient's psoriatic arthritis medication, particularly if they are on immunosuppressive agents like TNF inhibitors or methotrexate, may need temporary discontinuation during the acute infection phase, with consultation from rheumatology, considering the guidelines for treatment of psoriatic arthritis 1. Close monitoring of leukocyte count, inflammatory markers (CRP, ESR), and clinical symptoms is essential to assess treatment response. Repeat imaging should be performed if clinical improvement stalls to ensure complete resolution of the abscess. This approach combines source control through drainage with appropriate antimicrobial therapy to effectively treat the abscess while managing the underlying autoimmune condition. It is also important to consider the patient's overall health status and potential contraindications to certain treatments, as well as the need for close monitoring and potential adjustments to the treatment plan, as suggested by the guidelines 1.

From the FDA Drug Label

1. 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.
2. 1 Adult Patients The recommended dose of meropenem for injection is 500 mg given every 8 hours for skin and skin structure infections and 1 gram given every 8 hours for intra-abdominal infections.

The treatment for a 2 cm intra-abdominal abscess in psoriatic arthritis (PsA) with leukocytosis is Meropenem 1 gram given every 8 hours via intravenous infusion over approximately 15 minutes to 30 minutes 2.

• Key considerations:
  • The presence of leukocytosis suggests a possible bacterial infection, and Meropenem is effective against a range of bacteria that may cause intra-abdominal infections.
  • The dose and administration of Meropenem should be adjusted according to renal function, if necessary.

From the Research

Treatment for Intra-Abdominal Abscess

The treatment for a 2 cm intra-abdominal abscess in psoriatic arthritis (PsA) with leukocytosis involves several approaches, including:

• Prompt recognition and early localization of the abscess 3
• Effective drainage, which can be achieved through percutaneous or open surgical drainage 4, 5, 3
• Appropriate antimicrobial use, with broad-spectrum antibiotics given until culture and sensitivity data are obtained 3

Antibiotic Therapy

The choice of antibiotic therapy depends on the microbiological epidemiology of the intra-abdominal abscess. Studies have shown that:

• Piperacillin-tazobactam exhibits high CIAA/Cplasma ratios and rates of target achievement, making it a suitable option for treatment 6
• Meropenem also shows high rates of target achievement, although its efficacy may vary depending on the specific circumstances 6
• Gram-negative bacteria are susceptible to amoxicillin-acid clavulanic, piperacillin-tazobactam, cefotaxime, and meropenem, with varying degrees of susceptibility 7
• Gram-positive bacteria show susceptibility to amoxicillin-clavulanic acid, piperacillin-tazobactam, and meropenem, although the susceptibility rate decreases for cefotaxime 7

Considerations for Treatment

When treating intra-abdominal abscesses, it is essential to consider the following factors:

• The size and location of the abscess, as well as the presence of any underlying conditions that may have contributed to its formation 5, 3
• The risk of complications, such as advanced age, obesity, complex abscesses, and high Acute Physiology and Chronic Health Evaluation (APACHE) II or APACHE III scores 3
• The need for monitoring and evaluation after drainage to prevent worsening symptoms or recurrence 5