0508ida(h).qxd

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,

Source: http://medicaldevicedaily.com/img/ida052008_table3.pdf