'monotherapy' in low-risk community-acquired intra-abdominal infections

Q: 28 year old man is admitted to ICU with severe abdominal pain. CT scan is consistent with appendiceal abscess. Which of the following antibiotics can be used as a 'monotherapy' in low-risk community-acquired intra-abdominal infections?

A) Piperacillin-tazobactam
B) Metronidazole
C) Cefuroxime
D) Cefotaxime
E) Levofloxacin


Answer: A

This question is written to reinforce the idea of antibiotics stewardship, simplify the regimen to avoid medication errors, and to shun the practice of dual antibiotics coverage on each admission. Low-risk community-acquired intra-abdominal infections are generally defined as those that are of mild-to-moderate severity in the absence of risk factors for antibiotic resistance or treatment failure. Other antibiotics which can be used in such situations are ertapenem, ticarcillin-clavulanate, cefoxitin, moxifloxacin, and tigecycline.

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#surgicalcriticalcare


References:

1. Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010; 50:133.

2. Ohlin B, Cederberg A, Forssell H, et al. Piperacillin/tazobactam compared with cefuroxime/ metronidazole in the treatment of intra-abdominal infections. Eur J Surg 1999; 165:875. 

3. Cohn SM, Lipsett PA, Buchman TG, et al. Comparison of intravenous/oral ciprofloxacin plus metronidazole versus piperacillin/tazobactam in the treatment of complicated intraabdominal infections. Ann Surg 2000; 232:254. 

4.  Sartelli M, Catena F, Abu-Zidan FM, et al. Management of intra-abdominal infections: recommendations by the WSES 2016 consensus conference. World J Emerg Surg 2017; 12:22.