Newer cephalosporins: lessons to be learned from clinical trials in intraabdominal infections.
Recent clinical trials testing the efficacy of newer cephalosporins in intraabdominal infections lack a number of the study design criteria proposed by Solomkin et al. Nevertheless, these trials all support the use of these newer cephalosporins in the treatment of intraabdominal infections. These newer agents demonstrate increased in vitro antimicrobial activity against potential aerobic pathogens, which suggests that they may be used in combination with an antianaerobic drug in the treatment of intraabdominal infections. Therefore, agents including cefotaxime, cefoperazone, ceftazidime, cefuroxime, ceftriaxone, and aztreonam may be chosen in place of the standard aminoglycoside. Previous studies have demonstrated the necessity of both aerobic and anaerobic coverage in empiric therapy of intraabdominal infections. Cefotetan, ceftizoxime, cefoxitin, moxalactam, mezlocillin, and piperacillin all have in vitro activity against aerobes and anaerobes (including B. fragilis), thus, these agents have a potential as monotherapy for acute intraabdominal infections in otherwise healthy patients. Directed combination chemotherapy or perhaps imipenem alone is recommended for persistent peritonitis and intraabdominal infections in immunocompromised hosts.
Bumgardner
G L
GL
Department of Surgery, University of Minnesota School of Medicine, Minneapolis.
Simmons
R L
RL
D000038:Abscess / Q000188:drug therapy; D001424:Bacterial Infections / Q000188:drug therapy*; D002511:Cephalosporins / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D009181:Mycoses / Q000188:drug therapy; D012107:Research Design; D013530:Surgical Wound Infection / Q000188:drug therapy
D002511:Cephalosporins