Factors affecting the choice of antimicrobial therapy for anaerobic infection

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Abstract
The microbiological and clinical factors considered in the selection of appropriate antimicrobial therapy of anaerobic infections include: (1) the in-vitro activity of the drug against the pathogens; (2) the ability of the compounds to penetrate the infected site and resist inactivation; (3) the proven efficacy of the antimicrobial agents in wellcontrolled, randomized prospective studies as compared to established therapy and (4) comparison of the side effects of the drugs. The resistance of anaerobic bacteria to a number of antimicrobial agents has an impact on the first three factors. Within the Bacteroides group there is widespread resistance to penicillin, cephalosporins, and tetracycline compounds. While there have been scattered reports of resistance to clindamycin and cefoxitin, resistance to chloramphenicol and nitroimidazoles remain rare. Increased resistance to penicillin G and tetracycline has also been noted in Bact. melaninogenicus. Bact. bivius, Bad. disiens and the anaerobic cocci. Transfer of resistance to penicillin, tetracycline, and clindamycin-erythromycin has been demonstrated in Bact. fragilis and transfer of tetracycline resistance has been documented in clostridia. The penetration of drugs to the site of infection can be predicted from suitable animal models and knowledge of the agents' ability to be active in the hostile anaerobic environment. At present there are five classes of antimicrobial agents that are useful in the treatment of anaerobic infections including those involving Bact. fragilis : (I) nitroimidazoles—metronidazole, ornidazole, and tinidazole; (2) clindamycin; (3) chloramphenicol; (4) cefoxitin and moxalactam, and (5) semi-synthetic penicillins—carbenicillin, ticarcillin and piperacillin. Data on available randomized studies with these agents are reviewed.

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