(精选)Choice of Antibiotics in Uncomplicated and Complicated Diverticulitis教学课件.pptVIP

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(精选)Choice of Antibiotics in Uncomplicated and Complicated Diverticulitis教学课件.ppt

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Choice of Antibiotics in Diverticulitis Jeff Poynter University of Michigan Medical School The Problem: Uncomplicated Diverticulitis Uncomplicated diverticulitis represents a localized infection, primarily by Gram-negative rods and anaerobes, mostly E. coli and B. fragilis. (Ambrosetti P, et al.) Conservative (medical) treatment of acute uncomplicated diverticulitis is successful in 70-100% of patients. (Janes, et al. and Detry, et al.) Some Common Choices of Antibiotics: Dual-Agent Coverage Quinolone with metronidazole (Ciprofloxacin, 500 mg PO BID plus metronidazole, 500 mg PO BID) Ciprofloxacin 400 mg IV q 12 hours plus metronidazole 500 mg PO/IV q 6-8 hours Levofloxacin 500 mg IV daily plus metronidazole 500 mg PO/IV q 6-8 hours Choices made in part with regard to history of drug allergies Some Common Choices of Antibiotics: Single-Agent Therapy Amoxicillin-clavulanate 875/125 mg PO BID Ampicillin-sulbactam 3 g IV q 6 hours Piperacillin-tazobactam 3.375 or 4.5 g IV q 6 hours Ticarcillin-clavulanate 3.1 g IV q 4 hours Imipenem 500 mg IV q 6 hours Meropenem 1 g IV q 8 hours Single- versus Dual-Antibiotic Therapy Single and multiple antibiotic regimens are equally effective as long as both Gram-negative rods and anaerobes are covered adequately. (Kellum, et al.) The Problem: Complicated Diverticulitis Complications include obstruction, abscess formation, fistula formation or perforation. Requires IV antibiotics plus surgery (usually Hartmann operation). Antibiotics in Complicated Diverticulitis Ampicillin 2 g IV q 6 hours plus gentamicin 1.5-2.0 g IV q 8 hours plus metronidazole 500 mg IV q 8 hours Imipenem/cilastin 500 mg IV q 6 hours Piperacillin-tazobactam 3.375 mg IV q 6 hours Moxifloxacin Tigecycline, a new drug, has recently been approved for the treatment of intra-abdominal infections; it has not been shown to be superior to the traditional regimens. Lots of choices- the goal is to cover GNRs and anaerobes and proceed to definitive surgery. No single r