Antimicrobial resistance and the management of anaerobic infections.
Management of anaerobic infections encompasses surgical procedures, antibacterial therapy and adjuncts. At present, metronidazole, penems, beta-lactam/beta-lactamase inhibitor combinations and chloramphenicol have the highest activity against obligate anaerobes. Tigecycline is a promising new agent. Other antibacterials (e.g., nitazoxanide, moxifloxacin, garenoxacin and ramoplanin) and nonantibiotic agents show potential but need further investigation. The patient's characteristics, mixed anaerobic/aerobic infections, infection sites, bacterial resistance patterns, bactericidal activity of agents and their pharmacokinetics, toxicity and influence on the normal flora should be considered. Susceptibility patterns of anaerobes have become less predictable owing to increasing antibacterial resistance. Emergence of highly virulent or multidrug-resistant strains is challenging the current therapy. To counteract these trends, regular resistance surveillance in anaerobes, rational antibiotic use and evaluation of new treatment alternatives are important.
Department of Microbiology, Medical University of Sofia, Sofia, Bulgaria. lboyanova@hotmail.com
Lyudmila
L
Boyanova
Rossen
R
Kolarov
Ivan
I
Mitov
D000818:Animals; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000188:drug therapy; D001421:Bacteria, Anaerobic; D001424:Bacterial Infections / Q000188:drug therapy*; D001906:Botulism / Q000188:drug therapy; D017719:Diabetic Foot / Q000150:complications; D024881:Drug Resistance, Bacterial; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy; D006801:Humans; D008826:Microbial Sensitivity Tests; D014946:Wound Infection / Q000188:drug therapy; D018440:beta-Lactam Resistance