[Antibiotic treatment of intra-abdominal and post-surgical infections]

During the last years we observed a significant decrease of the mortality following the intra-abdominal infections thanks the improvement of surgical techniques and because of the improved approach of antibiotic treatments. The antibiotic therapy for the treatment of intra-abdominal infections greatly varies according to the infection severity. It is, in fact, possible to distinguish the intra-abdominal infections in three different categories. Mild infections should be treated promptly with surgical drainage and a short term therapy with a wide range antibiotic including anaerobes (ampicillin/sulbactam, cefoxitin). Mild-moderate infections which are largely the most frequent in the clinical practice should be also treated with a single drug which include anaerobes in its spectrum. Finally severe infections require a more aggressive therapeutic approach with a combination treatment covering anaerobes (clyndamicin, metronidazole), Gram negative rods (ciprofloxacin, aminoglycosides) and Gram positive cocci (penicillins, cephalosporins) including MRSA (glycopetides) and/or VRE (linezolid). By the surgical point of view the control of intra-abdominal infections can require different procedures such as laparatomy, relaparotomy or less frequently laparostomy (totally or partially open abdomen). A strong synergy between the surgical procedures and antibiotic therapy represents the best way to approach and resolve even the most severe intra-abdominal infections.