Recommended Agents for the Treatment of Community-
nutritional status, or immunosuppression)
Acquired Complicated Intra-Abdominal Infections (IDSA Guidelines 2003)
broader spectrum of activity against facul-
Classification of agent Agent(s) for mild to Agent(s) for high- moderate infections severity infections
pathogens.3 Refer to Table 3 for agents
infections occur as a result of complications
abdominal operations, and are caused bymore resistant pathogens,
Pseudomonas aeruginosa, Enterobacter
Staphylococcus aureus, enterococci, and
Note: moxifloxacin is
Candida spp. These infections often require
FDA-approved for use as monotherapy (new indication).
nosocomial resistance patterns dictateempirical treatment. Once results of micro-
• Note: this agent was
obtained, antimicrobial therapy should be
not mentioned in the IDSA guidelines, but is FDA-approved for use as monotherapy
* Phase III clinical trial conducted by Solomkin et al. (2007) resulted in Doripenem cure rates to
be comparable to Meropenem cure rates for complicated intra-abdominal infections. Doripenem
was FDA approved for complicated intra-abdominal infections in 2007. ** Gatifloxacin (Tequin ®) (IV/PO) has been removed from the market in 2006.
able results observed in several studies. However, doripenem has since been tested
to be safe and effective for the use in cIAI.
tive or percutaneous intervention.3 There is a wide vari-ety of conditions associated with cIAI, including perfo-
In 2007, Solomkin and colleagues performed two
rated gastroduodenal ulcers, biliary tract infections,
phase III clinical trials comparing doripenem (500 mg
small bowel perforations, appendicitis, and diverticuli-
IV q8h) to meropenem (1 g IV q8h) for the treatment
tis.4 The pathogens causing cIAI vary depending on
of complicated intra-abdominal infections in 962
whether the infection is community-acquired or health
patients. There was an optional stepdown therapy in
care-associated. Empirical treatment will be dependent
which patients could be switched to amoxicillin/clavu-
on the type of infection the patient presents with upon
lanate (875 mg PO BID) after nine IV doses, for a total
of 5-14 days of treatment if necessary. The primary
According to the 2003 Infectious Diseases Society
end point was a clinical response within 21 to 60 days
of America (IDSA) Guidelines, empiric antimicrobial
after treatment completion. Results of the trial showed
agents for community-acquired intra-abdominal
that clinical cure rates of microbiologically-evaluable
infections should cover enteric Gram-negative aerobic
patients were 84.6% for doripenem and 84.1% for
and facultative bacilli, as well as β-lactam-susceptible
meropenem (treatment difference, 0.5%; 95% CI, -
Gram-positive cocci. Additionally, coverage for obli-
5.5% to 6.4%), making doripenem non-inferior to
gate anaerobic bacilli is needed for distal small-
meropenem. Based on these findings, doripenem use
bowel, colon-derived infections, and for more proxi-
in cIAI may be comparable to the use of meropenem.5
mal perforations when obstruction is present.
Doripenem is indicated as a single agent for use in the
Narrower spectrum agents that are not commonly
treatment of complicated intra-abdominal infections
used for nosocomial infections are preferred over
caused by susceptible strains of E. coli, K. pneumoniae,
broader spectrum antimicrobials for mild-to-moderate
P. aeruginosa, B. caccae, B. fragilis, B. thetaiotaomi-
community-acquired intra-abdominal infections. cron, B. uniformis, B. vulgatus, S. intermedius, S. con-
High-severity infections (higher APACHE II scores,
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