Treatment of anaerobic infection.
Anaerobic bacteria are the predominant flora in the normal human skin and mucous membranes and are, therefore, a common cause of endogenous infections. Since anaerobic infections are generally polymicrobial, where anaerobes are mixed with aerobic organisms, therapy should provide coverage of both types of pathogens. The isolation of anaerobes requires appropriate methods of collection, transportation and cultivation of specimens. The lack of use of any of these methods can lead to inadequate recovery of anaerobes and inappropriate therapy. Treatment of anaerobic infection is complicated by the slow growth of these organisms and the growing resistance of anaerobic bacteria to antimicrobials. The primary role of antimicrobials is to limit the local and systemic spread of infection. Surgical drainage is of primary importance. This includes debriding of necrotic tissue, draining the pus, improving circulation, alleviating obstruction and increasing tissue oxygenation. The most effective antimicrobials against anaerobic organisms are metronidazole, the carbapenems (imipenem, meropenem and ertapenem), chloramphenicol, the combinations of a penicillin and a beta-lactamase inhibitor (ampicillin or ticarcillin plus clavulanate, amoxicillin plus sulbactam, and piperacillin plus tazobactam), tigecycline and clindamycin.
Georgetown University School of Medicine, Department of Pediatrics, 4431 Albemarle St NW, Washington, DC 20016, USA. ib6@georgetown.edu
Itzhak
I
Brook
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001421:Bacteria, Anaerobic / Q000187:drug effects / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D015780:Carbapenems / Q000627:therapeutic use; D002701:Chloramphenicol / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D008911:Minocycline / Q000031:analogs & derivatives / Q000627:therapeutic use; D054843:Negative-Pressure Wound Therapy; D010406:Penicillins / Q000627:therapeutic use; D000078304:Tigecycline; D065093:beta-Lactamase Inhibitors; D001618:beta-Lactamases / Q000627:therapeutic use
D000890:Anti-Infective Agents; D015780:Carbapenems; D010406:Penicillins; D065093:beta-Lactamase Inhibitors; D008795:Metronidazole; D002981:Clindamycin; D002701:Chloramphenicol; D000078304:Tigecycline; D001618:beta-Lactamases; D008911:Minocycline