A Randomized Prospective Study of Cefepime Plus Metronidazole with Imipenem-Cilastatin in the Treatment of Intra-abdominal Infections

Garbino, Jorge; Villiger, Peter M.; Caviezel, Alessandro Reto; Matulionytė, Raimonda; Uçkay, İlker; Morel, P; Lew, Daniel Pablo

doi:10.1007/s15010-007-6237-2

Cited by 18 publications

(18 citation statements)

References 24 publications

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“…Cefepime, is a fourth-generation cephalosporin, with broader spectrum activity than third generation cephalosprins and effective against AmpC-producing organisms [290]. For empiric therapy, also cefepime should also be combined with metronidazole because it does not possess anti-anaerobic activity [291]. …”

Section: Antimicrobial Therapymentioning

confidence: 99%

The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections

et al. 2017

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Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide.The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important.In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs.The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.

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Section: Antimicrobial Therapymentioning

confidence: 99%

The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections

et al. 2017

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“…It was introduced into clinical practice in 1994 and is used in association with metronidazole for the treatment of severe infections [122]. Cefepime possesses higher in vitro activity than other extended-spectrum cephalosporins against common Gram-negative and Gram-positive pathogens and may be effective, in association with metronidazole, in high risk intra-abdominal infections [103,123].…”

Section: Antimicrobial Therapy In Intra-abdominal Infectionsmentioning

confidence: 99%

A focus on intra-abdominal infections

2010

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Complicated intra-abdominal infections are an important cause of morbidity and are frequently associated with poor prognosis, particularly in higher risk patients.Well defined evidence-based recommendations for intra-abdominal infections treatment are partially lacking because of the limited number of randomized-controlled trials.Factors consistently associated with poor outcomes in patients with intra-abdominal infections include increased illness severity, failed source control, inadequate empiric antimicrobial therapy and healthcare-acquired infection.Early prognostic evaluation of complicated intra-abdominal infections is important to select high-risk patients for more aggressive therapeutic procedures.The cornerstones in the management of complicated intra-abdominal infections are both source control and antibiotic therapy.The timing and the adequacy of source control are the most important issues in the management of intra-abdominal infections, because inadequate and late control of septic source may have a negative effect on the outcomes.Recent advances in interventional and more aggressive techniques could significantly decrease the morbidity and mortality of physiologically severe complicated intra-abdominal infections, even if these are still being debated and are yet not validated by limited prospective trials.Empiric antimicrobial therapy is nevertheless important in the overall management of intra-abdominal infections. Inappropriate antibiotic therapy may result in poor patient outcomes and in the appearance of bacterial resistance.Antimicrobial management is generally standardised and many regimens, either with monotherapy or combination therapy, have proven their efficacy. Routine coverage especially against Enterococci and candida spp is not always recommended, but can be useful in particular clinical conditions. A de escalation approach may be recommended in patients with specific risk factors for multidrug resistant infections such as immunodeficiency and prolonged antibacterial exposure.Therapy should focus on the obtainment of adequate source control and adequate use of antimicrobial therapy dictated by individual patient risk factors. Other critical issues remain debated and more controversies are still open mainly because of the limited number of randomized controlled trials.

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“…Among third generation cephalosporins both subgroups with poor activity against Pseudomonas aeruginosa and with activity against Pseudomonas aeruginosa (cefepime and ceftazidime) have been used in the treatment of IAIs in association with metronidazole. Both cephalosporins have acquired resistance in enterobacteriaceae and intrinsic resistance in Enterococci [185-188]. In light of the emerging concern of ESBL producing enterobacteriaceae species due to selection pressure by increase use of cephalosporins, the routinely use of all cephalosporins should be discouraged.…”

Section: Extra-biliary Community-acquired Intra-abdominal Infectionsmentioning

confidence: 99%

WSES consensus conference: Guidelines for first-line management of intra-abdominal infections

et al. 2011

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Intra-abdominal infections are still associated with high rate of morbidity and mortality.A multidisciplinary approach to the management of patients with intra-abdominal infections may be an important factor in the quality of care. The presence of a team of health professionals from various disciplines, working in concert, may improve efficiency, outcome, and the cost of care.A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bologna on July 2010, during the 1st congress of the WSES, involving surgeons, infectious disease specialists, pharmacologists, radiologists and intensivists with the goal of defining recommendations for the early management of intra-abdominal infections.This document represents the executive summary of the final guidelines approved by the consensus conference.

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A Randomized Prospective Study of Cefepime Plus Metronidazole with Imipenem-Cilastatin in the Treatment of Intra-abdominal Infections

Abstract: Further studies are warranted to confirm the better results with the cefepime + metronidazole regimen for the treatment of intra-abdominal infections.

Cited by 18 publications

References 24 publications

The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections

The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections

A focus on intra-abdominal infections

WSES consensus conference: Guidelines for first-line management of intra-abdominal infections

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