Ann Surg Treat Res.  2015 Jul;89(1):43-47. 10.4174/astr.2015.89.1.43.

Clinical characteristics of ceftriaxone plus metronidazole in complicated intra-abdominal infection

• Bae JM

• KMID: 2047713
• DOI: http://doi.org/10.4174/astr.2015.89.1.43

Abstract

PURPOSE
Empirical antibiotics in complicated intra-abdominal infection (c-IAI), such as secondary peritonitis are a first step of treatment. Empirical antibiotic regimen is very diverse. Ceftriaxone plus metronidazole regimen (CMR) is one of the empirical antibiotic regimens used in treatment of c-IAI. However, although CMR is a widely used empirical antibiotic regimen, study regarding success, failure or efficacy of CMR has been poorly understood. This retrospective study is conducted to compare the clinical efficacy of this regimen in c-IAI according to clinical characteristics.
METHODS
The subjects were patients in this hospital who were diagnosed as secondary peritonitis between 2009 and 2013. Retrospective analysis was performed based on the records made after surgery regarding clinical characteristics including albumin level, blood pressure, pulse rate, respiration rate, smoking, age, sex, body mass index, hemoglobin, coexisting disease, leukocytosis, and APACHE (acute physiology and chronic health evaluation) II score.
RESULTS
A total of 114 patients were enrolled. In univariated analysis, the success and failure of CMR showed significant association with preoperative low albumin, old age, and preoperative tachycardia. In multivariated analysis, low albumin and preoperative tachycardia were significant.
CONCLUSION
It is thought that an additional antibiotic treatment plan is necessary in patients with low albumin and tachycardia when the empirical antibiotic regimen is CMR in c-IAI. Conduct of research through well-designed prospective randomized clinical study is also necessary in order to evaluate the appropriateness of CMR and decide on a proper empirical antibiotic regimen between many regimens in c-IAI based on our country.

Keyword

Peritonitis; Ceftriaxone; Metronidazole

MeSH Terms

Anti-Bacterial Agents
APACHE
Blood Pressure
Body Mass Index
Ceftriaxone*
Heart Rate
Humans
Intraabdominal Infections*
Leukocytosis
Metronidazole*
Peritonitis
Physiology
Respiratory Rate
Retrospective Studies
Smoke
Smoking
Tachycardia
Anti-Bacterial Agents
Ceftriaxone
Metronidazole
Smoke

Reference

1. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, 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. Surg Infect (Larchmt). 2010; 11:79–109.

2. Sartelli M, Viale P, Catena F, Ansaloni L, Moore E, Malangoni M, et al. 2013 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2013; 8:3.

3. Marshall JC, Innes M. Intensive care unit management of intra-abdominal infection. Crit Care Med. 2003; 31:2228–2237.

4. Menichetti F, Sganga G. Definition and classification of intra-abdominal infections. J Chemother. 2009; 21:Suppl 1. 3–4.

5. Solomkin JS, Mazuski JE, Baron EJ, Sawyer RG, Nathens AB, DiPiro JT, et al. Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections. Clin Infect Dis. 2003; 37:997–1005.

6. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest. 1992; 101:1644–1655.

7. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013; 39:165–228.

8. Barie PS. Surgical infections and antibiotic use. In : Townsend CM, Beauchamp RD, Evers BM, Mattox KL, editors. Sabiston textbook of surgery: expert consult premium edition: enhanced online features. 19th ed. London: Elsevier Health Sciences;2012. p. 255.

9. Luke M, Iversen J, Sondergaard J, Kvist E, Lund P, Andersen F, et al. Ceftriaxone/metronidazole is more effective than ampicillin/netilmicin/metronidazole in the treatment of bacterial peritonitis. Eur J Surg. 1991; 157:397–401.

10. Bohnen JM, Solomkin JS, Dellinger EP, Bjornson HS, Page CP. Guidelines for clinical care: anti-infective agents for intra-abdominal infection: a Surgical Infection Society policy statement. Arch Surg. 1992; 127:83–89.

11. Park JB, Je GY, Kim SG, Jo YK. Therapeutic effects of ceftriaxone in surgical patients. J Korean Surg Soc. 1986; 30:727–731.

12. Swenson BR, Metzger R, Hedrick TL, McElearney ST, Evans HL, Smith RL, et al. Choosing antibiotics for intra-abdominal infections: what do we mean by "high risk"? Surg Infect (Larchmt). 2009; 10:29–39.

13. Cho YK, Lee J, Suh SO, Kim SW, Jang JY, Kim SG, et al. A randomized, controlled, open, multi-center clinical trial comparing ertapenem versus ceftriaxone plus metronidazole for the treatment of complicated intra-abdominal infections in adults. Infect Chemother. 2005; 37:330–336.

14. Qvist N, Warren B, Leister-Tebbe H, Zito ET, Pedersen R, McGovern PC, et al. Efficacy of tigecycline versus ceftriaxone plus metronidazole for the treatment of complicated intra-abdominal infections: results from a randomized, controlled trial. Surg Infect (Larchmt). 2012; 13:102–109.

15. Towfigh S, Pasternak J, Poirier A, Leister H, Babinchak T. A multicentre, open-label, randomized comparative study of tigecycline versus ceftriaxone sodium plus metronidazole for the treatment of hospitalized subjects with complicated intra-abdominal infections. Clin Microbiol Infect. 2010; 16:1274–1281.

16. Berger DH, Dardik A, Rosenthal RA. Surgery in the geriatric patient. In : Townsend CM, Beauchamp RD, Evers BM, Mattox KL, editors. Sabiston textbook of surgery: expert consult premium edition: enhanced online features. 19th ed. London: Elsevier Health Sciences;2012. p. 335.

17. Raynaud-Simon A, Revel-Delhom C, Hebuterne X. French Nutrition and Health Program, French Health High Authority. Clinical practice guidelines from the French Health High Authority: nutritional support strategy in protein-energy malnutrition in the elderly. Clin Nutr. 2011; 30:312–319.

18. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. Perioperative total parenteral nutrition in surgical patients. N Engl J Med. 1991; 325:525–532.

19. Leibovici L, Gafter-Gvili A, Paul M, Almanasreh N, Tacconelli E, Andreassen S, et al. Relative tachycardia in patients with sepsis: an independent risk factor for mortality. QJM. 2007; 100:629–634.