From the Guidelines
For treating abdominal infections without liver toxicity, the most appropriate antibiotic options include ceftriaxone, cefotaxime, aztreonam, metronidazole, and carbapenems like meropenem, as they have minimal liver metabolism and are effective against a broad range of pathogens 1. When selecting an antibiotic, it is essential to consider the severity of the infection, the presence of anaerobic bacteria, and the potential for antibiotic resistance.
- For mild-to-moderate community-acquired infections, single-agent therapy with ticarcillin-clavulanate, cefoxitin, ertapenem, moxifloxacin, or tigecycline is recommended, or combinations of metronidazole with cefazolin, cefuroxime, ceftriaxone, cefotaxime, levofloxacin, or ciprofloxacin 1.
- Anaerobic coverage should be provided for distal small bowel, appendiceal, and colon-derived infections, and for more proximal gastrointestinal perforations in the presence of obstruction or paralytic ileus 1.
- The use of aminoglycosides is not recommended for routine use in adults with community-acquired intra-abdominal infection due to the availability of less toxic agents with equal efficacy 1.
- Empiric antifungal therapy for Candida is not recommended for adult and pediatric patients with community-acquired intra-abdominal infection 1.
- Treatment duration typically ranges from 5-14 days, depending on infection severity and clinical response, and monitoring renal function is crucial, especially with cephalosporins and carbapenems, as dosage adjustments may be needed in kidney impairment 1.
From the Research
Antibiotics for Abdominal Infections
To treat abdominal infections without causing liver toxicity, several antibiotics can be considered. The choice of antibiotic depends on the type of infection, the causative microorganisms, and the patient's medical history.
Suitable Antibiotics
- Ciprofloxacin plus metronidazole: This combination has been shown to be effective in treating complicated intra-abdominal infections, with a clinical success rate of 98.9% 2.
- Ertapenem: A parenteral carbapenem with a broad spectrum of activity against bacteria associated with community-acquired infections, including those of complicated intra-abdominal conditions 3.
- Ceftriaxone plus metronidazole: This combination is appropriate as empirical therapy for patients with perforated appendicitis and cholecystitis, but may not be sufficient for cases involving perforated small and large bowel, including complicated sigmoid diverticulitis 4.
Considerations
- The microbiological profile of the infection should be considered when selecting an antibiotic regimen, as some microorganisms may be resistant to certain antibiotics 5, 4.
- The use of broader spectrum antimicrobial therapy may be necessary in cases where antibiotic-resistant organisms are suspected or identified 4.
- The treatment of abdominal infections should include surgical correction and drainage of pus, in addition to the administration of antimicrobials effective against both aerobic and anaerobic pathogens 5.