New French guidelines recommend a levofloxacin combination as an empirical anti-infective therapy
Intra-abdominal infections are one of the most frequent causes of medical emergencies involving the gastrointestinal tract. The first French consensus on the management of community-acquired peritonitis was published in the year 2000 and updated guidelines have concentrated on three main topics: the management of community-acquired infection, intra-abdominal infection in children and healthcare-associated infections. The latest Clinical Practice Guidelines (CPGs) provide a detailed analysis of treatment recommendations based on the GRADE method which involves a quantitative analysis of the published literature with determinations of the quality of evidence. These recommendations were carefully considered and approved by a review committee consisting of experts from across France.
The review had six principal themes: the diagnostic approach, infection source control, microbiological data, paediatric specificities, medical treatment of peritonitis and management of complications. In all, there were a total of 44 recommendations and a strong agreement of experts (100%) was obtained for all of these recommendations.
R18 of these recommendations describes the expert opinion supporting the use of a combination of levofloxacin +gentamicin + metronidazole or, in the absence of any other treatment option, tigecycline should probably be used to treat community-acquired infections in patients with documented beta-lactam allergy. A combination of a fluoroquinolone like levofloxacin and gentamicin can be used to treat resistant Enterobacteriaceae and the addition of a nitroimidazole, like metronidazole, is essential for targeting anaerobic bacteria. In the absence of other options, tigecycline is an alternative because it is active against Enterobacteriaceae including ESBL (extended-spectrum beta-lactamase)-producing strains.
Anaesth Crit Care Pain Med. 2015 Apr;34(2):117-30. doi: 10.1016/j.accpm.2015.03.005. Epub 2015 Apr 24.
Source : http://www.ncbi.nlm.nih.gov/pubmed/25922057?dopt=Abstract