Intra-abdominal infections Flashcards
What are the common types of intra-abdominal infections?
Acute diverticulitis, Acute cholecystitis, Ascending cholangitis, Appendicitis, Spontaneous bacterial peritonitis, Intra-abdominal abscess
These infections can vary in severity and treatment approaches.
What are the common bacterial causes of intra-abdominal infections?
Anaerobes (e.g., Bacteroides, Clostridium), E. coli (gram-negative), Klebsiella (gram-negative), Enterococcus (gram-positive), Streptococcus (gram-positive)
What are the key principles in antibiotic treatment for intra-abdominal infections?
Broad-spectrum antibiotics are required until culture results are available, Antibiotics need to cover gram-positive, gram-negative, and anaerobic bacteria
Initial broad-spectrum coverage is crucial due to the polymicrobial nature of these infections.
What antibiotic provides good coverage for gram-positive, gram-negative, and anaerobic bacteria?
Co-amoxiclav provides broad-spectrum coverage but does not cover pseudomonas or atypical bacteria.
It is often used as first-line therapy in many intra-abdominal infections.
What is the role of quinolones (e.g., ciprofloxacin, levofloxacin) in the treatment of intra-abdominal infections?
Quinolones provide coverage for gram-positive, gram-negative, and atypical bacteria, They do not cover anaerobes, so they are often paired with metronidazole for anaerobic coverage.
This combination is common in clinical practice for comprehensive coverage.
What is the role of metronidazole in intra-abdominal infections?
Metronidazole provides excellent coverage for anaerobes but does not cover aerobic bacteria.
It is often used in conjunction with other antibiotics to ensure complete coverage.
What is the role of gentamicin in treating intra-abdominal infections?
Gentamicin provides excellent gram-negative coverage and some gram-positive coverage (especially against staph), It is bactericidal, meaning it kills bacteria rather than inhibiting their growth.
Its use is typically in combination with other antibiotics for broader efficacy.
What antibiotic provides excellent coverage against gram-positive bacteria, including MRSA?
Vancomycin provides excellent coverage for gram-positive bacteria, including MRSA.
It is often combined with gentamicin and metronidazole in patients with a penicillin allergy.
Why are cephalosporins not always the best choice for intra-abdominal infections?
Cephalosporins provide broad-spectrum coverage for gram-positive and gram-negative bacteria, However, they are not very effective against anaerobes and carry a risk of Clostridium difficile (C. diff) infection.
This risk can complicate treatment decisions.
What are the reserved antibiotics for severe cases of intra-abdominal infections?
Piperacillin with tazobactam (Tazocin) and meropenem are powerful antibiotics that cover gram-positive, gram-negative, and anaerobic bacteria.
These are reserved for very unwell patients and those who do not respond to other antibiotics.
What factors influence the choice of antibiotics for intra-abdominal infections?
Local antibiotic policies, Local resistance patterns, Infection control issues, The patient’s specific condition and needs
Tailoring antibiotic therapy is crucial for effective treatment and to combat resistance.
