Division of Infectious Diseases, Department of Internal Medicine, Show-Chwan Memorial Hospital, Changhua, Taiwan.
J Microbiol Immunol Infect. 2012 Feb;45(1):1-6. doi: 10.1016/j.jmii.2011.11.010. Epub 2012 Jan 12.
Complicated intra-abdominal infections (cIAIs) are common yet serious infections that can potentially lead to substantial morbidity and morbidity. As an essential adjunct to source control, the goals of antimicrobial therapy are to promote patient recovery, reduce recurrence risk, and prevent antimicrobial resistance. The current international guidelines on the empirical treatment of community-acquired complicated IAIs were published by the Infectious Diseases Society of America (IDSA) and Surgical Infections Society (SIS) in 2010. These guidelines all recommend the use of a fluoroquinolone (ciprofloxacin or levofloxacin) plus metronidazole for mild-to-moderate- and high-severity cases. Moxifloxacin monotherapy is recommended by the current IDSA/SIS guidelines for the treatment of mild-to-moderate complicated IAIs. Moxifloxacin has demonstrated a broad spectrum coverage of both aerobic and anaerobic pathogens, good tissue penetration into the gastrointestinal tract, and a good tolerability profile. Clinical data have demonstrated that moxifloxacin is at least as effective as other standard therapeutic regimens recommended by current clinical guidelines. Due to the high rates of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and fluoroquinolone-resistant Enterobacteriaceae among isolates causing community-acquired IAIs in Asia, any fluoroquinolones (including moxifloxacin) are not recommended as drugs of choice for the empirical treatment of community-acquired IAIs, particularly in countries (China, India, Thailand, and Vietnam) with fluoroquinolone resistance rates among Escherichia coli isolates of >20%. Given the low rates of fluoroquinolone-resistant (<20%) and extended-spectrum β-lactamase (ESBL)-producing (<10%) Enterobacteriaceae isolates associated community-acquired IAIs in Taiwan, it appears that moxifloxacin is considered an appropriate first-line therapy for patients with community-acquired complicated IAIs in this country.
复杂性腹腔内感染(cIAIs)较为常见且较为严重,可能导致较高的发病率和死亡率。作为控制感染源的重要辅助手段,抗菌治疗的目标是促进患者康复、降低复发风险和预防抗菌药物耐药性。2010 年,美国传染病学会(IDSA)和外科感染学会(SIS)发布了关于社区获得性复杂性腹腔内感染经验性治疗的国际指南。这些指南均推荐使用氟喹诺酮类药物(环丙沙星或左氧氟沙星)联合甲硝唑治疗轻至中度和重度感染。当前的 IDSA/SIS 指南推荐莫西沙星单药治疗轻至中度复杂性腹腔内感染。莫西沙星对需氧和厌氧病原体具有广谱覆盖,可良好穿透胃肠道组织,且具有良好的耐受性。临床数据表明,莫西沙星与当前临床指南推荐的其他标准治疗方案一样有效。由于亚洲社区获得性腹腔内感染分离株中广泛存在产超广谱β-内酰胺酶(ESBL)的肠杆菌科和氟喹诺酮耐药的肠杆菌科,任何氟喹诺酮类药物(包括莫西沙星)均不推荐作为经验性治疗社区获得性腹腔内感染的首选药物,尤其是在氟喹诺酮耐药率(大肠埃希菌分离株>20%)较高的国家(中国、印度、泰国和越南)。鉴于台湾社区获得性腹腔内感染分离株中氟喹诺酮耐药率(<20%)和产 ESBL 肠杆菌科的比例(<10%)较低,莫西沙星似乎被认为是该国社区获得性复杂性腹腔内感染患者的一线治疗药物。