Antimicrobial and antimycotic therapy of intra-abdominal infections

Antimicrobial chemotherapy is a cornerstone in the treatment of intra-abdominal infections (IAI). The initiation of initial antibiotic therapy must immediately follow the diagnosis of IAI. Selection of the antimicrobial agent is based on the expected pathogenic bacterial spectrum as a calculated empirical therapy. It is impossible to give general recommendations concerning the selection of a certain class of antimicrobial chemotherapeutics, since all available clinical trials were designed to prove noninferiority to the comparator product. Nevertheless several societies developed guidelines and recommendations based on the multitude of clinical trials investigating antimicrobial chemotherapeutics. The antibiotic therapy of postoperative peritonitis has to be implemented according to the patient's risk profile (antibiotic pretreatment, multiresistant pathogens, hospital epidemiology). The development of invasive peritoneal mycoses is rare. The therapy should be guided by the results of the microbiological work-up of the intraperitoneal cultures.