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Z Gastroenterol 2013; 51(09): 1069-1081
DOI: 10.1055/s-0033-1335043
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Kalkulierte Antibiotikatherapie bei intraabdominellen Infektionen – Fallbeispiele und evidenzbasierte Therapieempfehlungen

Empirical Antibiotic Therapy in Intra-Abdomial Infections: Cases and Evidence-Based Therapeutic Recommendations
A. Stallmach
1   Klinik für Innere Medizin, Innere Medizin IV, Universitätsklinikum Jena der FSU Jena
2   Interdisziplinäres Forschungs- und Behandlungszentrum (IFB) „Sepsis und Sepsisfolgen“ des Universitätsklinikums Jena der Friedrich-Schiller-Universität Jena (FSU)
,
S. Hagel
1   Klinik für Innere Medizin, Innere Medizin IV, Universitätsklinikum Jena der FSU Jena
2   Interdisziplinäres Forschungs- und Behandlungszentrum (IFB) „Sepsis und Sepsisfolgen“ des Universitätsklinikums Jena der Friedrich-Schiller-Universität Jena (FSU)
,
T. Bruns
1   Klinik für Innere Medizin, Innere Medizin IV, Universitätsklinikum Jena der FSU Jena
2   Interdisziplinäres Forschungs- und Behandlungszentrum (IFB) „Sepsis und Sepsisfolgen“ des Universitätsklinikums Jena der Friedrich-Schiller-Universität Jena (FSU)
,
M. Pletz
1   Klinik für Innere Medizin, Innere Medizin IV, Universitätsklinikum Jena der FSU Jena
2   Interdisziplinäres Forschungs- und Behandlungszentrum (IFB) „Sepsis und Sepsisfolgen“ des Universitätsklinikums Jena der Friedrich-Schiller-Universität Jena (FSU)
,
C. Eckmann
3   Klinik für Allgemeine Viszeral- und Thoraxchirurgie Klinikum Peine
› Author Affiliations
Further Information

Publication History

03 December 2012

30 January 2013

Publication Date:
10 September 2013 (online)

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Zusammenfassung

Intraabdominelle Infektionen (IAI) stellen in der Viszeralmedizin ein häufiges Problem dar. So werden in Deutschland pro Jahr mehr als 150 000 Patienten mit diesem Krankheitsbild behandelt. Dabei kann der Verlauf bei Betroffenen relativ blande sein; intraabdominelle Infektionen können aber auch schwerwiegend verlaufen. Sie bilden z. B. den zweithäufigsten Fokus bei der Sepsis bzw. dem septischen Schock und stellen die zweithäufigste Ursache für das infektionsbedingte Versterben auf der Intensivstation dar. Aufgrund zunehmender Resistenzen von Mikroorganismen, aber auch Veränderungen im Erregerspektrum und zunehmender Komorbiditäten der Patienten müssen Empfehlungen zur initialen kalkulierten Antibiotikatherapie ständig angepasst werden. Eine inadäquate Antibiotikatherapie der IAI verschlechtert substanziell die Prognose der betroffenen Patienten, zu „breite“ Behandlungen verschärfen aber mittelfristig die Resistenzproblematik. In dieser Übersicht werden – basierend auf nationalen und internationalen Leitlinien – an konkreten Beispielen typischer intraabdomineller Infektionen Empfehlungen zur Initialtherapie gegeben. Unter Berücksichtigung lokaler Resistenzraten und individueller patientenspezifischer Faktoren soll damit eine Basis für eine verbesserte Therapie dieses häufigen Problems geschaffen werden.

Abstract

Intra-abdominal infections (IAI) are a common problem in visceral medicine. In Germany more than 150 000 patients are treated each year for IAI with courses ranging from uncomplicated disease to severe life-threatening manifestations. IAI represent the second most common cause of septic shock and the second most common cause of infection-related mortality in intensive care. Due to increasing antimicrobial resistance, changes in pathogen spectra and increasing patient co-morbidities, recommendations for empirical antibiotic therapy have to be continuously updated: Whereas inadequate empirical treatment is associated with poor prognosis, unselected broad-spectrum therapy may increase antimicrobial resistances. Illustrated by clinical cases of typical intra-abdominal infections, this article reviews recommendations for antibiotic therapy based on national and international guidelines under consideration of local resistance rates and patient-specific factors to provide a basis for improved therapy of this common problem.

Schlüsselwörter

infektiöse Kolitis - Morbus Crohn - Leberzirrhose - Abszess - intrabdominelle Infektion

Key words

infectious colitis - Crohn’s disease - liver cirrhosis - abscess - intra-abdominal infections
 

  • Literatur

  • 1 Bodmann KF, Grabein B, Paul-Ehrlich-Gesellschaft Ed. Empfehlungen zur kalkulierten parenteralen Initialtherapie bakterieller Erkrankungen bei Erwachsenen. Chemother J 2010; 19: 177-258
    PubMedSearch in Google Scholar
  • 2 Brunkhorst FM. Epidemiology, economy and practice – results of the German study on prevalence by the competence network sepsis (SepNet). Anasthesiol Intensivmed Notfallmed Schmerzther 2006; 41: 43-44
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Solomkin JS, Mazuski JE, Bradley JS. et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010; 50: 133-164
    CrossrefPubMedSearch in Google Scholar
  • 4 Eckmann C, Dryden M, Montravers P. et al. Antimicrobial treatment of “complicated” intra-abdominal infections and the new IDSA guidelines? A commentary and an alternative European approach according to clinical definitions. Eur J Med Res 2011; 16: 115-126
    CrossrefPubMedSearch in Google Scholar
  • 5 DiPiro JT, Rogers DA. Intra-abdominal infections. In: DiPiro JT, Talbert RL, Yee GC. et al. (eds) Pharmacotherapy: a pathophysiological apporach. Stanford: Appleton and Lange; 1997: 2148
    Search in Google Scholar
  • 6 Maier S, Traeger T, Westerholt A. et al. Special aspects of abdominal sepsis. Chirurg 2005; 76: 829-836
    CrossrefPubMedSearch in Google Scholar
  • 7 Boucher HW, Talbot GH, Bradley JS. et al. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis 2009; 48: 1-12
    CrossrefPubMedSearch in Google Scholar
  • 8 Gatermann S, Chaberny IF, Pletz M. et al. Multiresistente pulmonale Erreger auf der Intensivstation. Der Pneumologe 2010; 7: 412-422
    CrossrefPubMedSearch in Google Scholar
  • 9 Rodriguez-Bano J, Picon E, Navarro MD. et al. Impact of changes in CLSI and EUCAST breakpoints for susceptibility in bloodstream infections due to extended-spectrum beta-lactamase-producing Escherichia coli. Clin Microbiol Infect 2012; 18: 894-900
    CrossrefPubMedSearch in Google Scholar
  • 10 Eckmann C, Shekarriz H. Antimicrobial management of complicated intra-abdominal infections caused by resistant bacteria. Eur Infect Dis 2012; 6: 22-27
    PubMedSearch in Google Scholar
  • 11 Paterson DL. “Collateral damage” from cephalosporin or quinolone antibiotic therapy. Clin Infect Dis 2004; 38 (Suppl. 04) S341-S345
    CrossrefPubMedSearch in Google Scholar
  • 12 Naas T, Nordmann P, Vedel G. et al. Plasmid-mediated carbapenem-hydrolyzing beta-lactamase KPC in a Klebsiella pneumoniae isolate from France. Antimicrob Agents Chemother 2005; 49: 4423-4424
    CrossrefPubMedSearch in Google Scholar
  • 13 Kaase M. Bericht des NRZ für gramnegative Krankenhauserreger. Carbapenemase-tragende gramnegative Erreger im Zeitraum Mai bis Juni 2010. Epidemiologisches Bulletin 2010; 28: 267
    PubMedSearch in Google Scholar
  • 14 Yahav D, Lador A, Paul M. et al. Efficacy and safety of tigecycline: a systematic review and meta-analysis. J Antimicrob Chemother 2011; 66: 1963-1971
    CrossrefPubMedSearch in Google Scholar
  • 15 Freire AT, Melnyk V, Kim MJ. et al. Comparison of tigecycline with imipenem/cilastatin for the treatment of hospital-acquired pneumonia. Diagn Microbiol Infect Dis 2010; 68: 140-151
    CrossrefPubMedSearch in Google Scholar
  • 16 Tasina E, Haidich AB, Kokkali S. et al. Efficacy and safety of tigecycline for the treatment of infectious diseases: a meta-analysis. Lancet Infect Dis 2011; 11: 834-844
    CrossrefPubMedSearch in Google Scholar
  • 17 Welte T, Pletz MW. Antimicrobial treatment of nosocomial meticillin-resistant Staphylococcus aureus (MRSA) pneumonia: current and future options. Int J Antimicrob Agents 2010; 36: 391-400
    CrossrefPubMedSearch in Google Scholar
  • 18 Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother 2005; 49: 3640-3645
    CrossrefPubMedSearch in Google Scholar
  • 19 Ruhnke M, Rickerts V, Cornely OA. et al. Diagnosis and therapy of Candida infections: joint recommendations of the German Speaking Mycological Society and the Paul-Ehrlich-Society for Chemotherapy. Mycoses 2011; 54: 279-310
    CrossrefPubMedSearch in Google Scholar
  • 20 Cornely OA, Bassetti M, Calandra T. European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect 2012; 18: 19-37
    CrossrefPubMedSearch in Google Scholar
  • 21 Bodmann KF. Komplizierte intraabdominelle Infektionen: Erreger, Resistenzen. Chirurg 2010; 81: 38-49
    CrossrefPubMedSearch in Google Scholar
  • 22 Gerbes AL, Gulberg V, Sauerbruch T. et al. German S 3-guideline “ascites, spontaneous bacterial peritonitis, hepatorenal syndrome”. Z Gastroenterol 2011; 49: 749-779
    Thieme ConnectPubMedSearch in Google Scholar
  • 23 Ginès P, Angeli P, Lenz K. et al. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 53: 397-417
    CrossrefPubMedSearch in Google Scholar
  • 24 Navasa M, Follo A, Llovet JM. et al. Randomized, comparative study of oral ofloxacin versus intravenous cefotaxime in spontaneous bacterial peritonitis. Gastroenterology 1996; 111: 1011-1017
    CrossrefPubMedSearch in Google Scholar
  • 25 Angeli P, Guarda S, Fasolato S. et al. Switch therapy with ciprofloxacin vs. intravenous ceftazidime in the treatment of spontaneous bacterial peritonitis in patients with cirrhosis: similar efficacy at lower cost. Aliment Pharmacol Ther 2006; 23: 75-84
    CrossrefPubMedSearch in Google Scholar
  • 26 Cheong HS, Kang CI, Lee JA. et al. Clinical significance and outcome of nosocomial acquisition of spontaneous bacterial peritonitis in patients with liver cirrhosis. Clin Infect Dis 2009; 48: 1230-1236
    CrossrefPubMedSearch in Google Scholar
  • 27 Umgelter A, Reindl W, Miedaner M. et al. Failure of current antibiotic first-line regimens and mortality in hospitalized patients with spontaneous bacterial peritonitis. Infection 2009; 37: 2-8
    CrossrefPubMedSearch in Google Scholar
  • 28 Fernandez J, Acevedo J, Castro M. et al. Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: a prospective study. Hepatology 2012; 55: 1551-1561
    CrossrefPubMedSearch in Google Scholar
  • 29 Ariza X, Castellote J, Lora-Tamayo J. et al. Risk factors for resistance to ceftriaxone and its impact on mortality in community, healthcare and nosocomial spontaneous bacterial peritonitis. J Hepatol 2012; 56: 825-832
    CrossrefPubMedSearch in Google Scholar
  • 30 Reuken PA, Pletz MW, Baier M. et al. Emergence of spontaneous bacterial peritonitis due to enterococci – risk factors and outcome in a 12-year retrospective study. Aliment Pharmacol Ther 2012; 35: 1199-1208
    CrossrefPubMedSearch in Google Scholar
  • 31 Fernandez J, Navasa M, Gomez J. et al. Bacterial infections in cirrhosis: epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology 2002; 35: 140-148
    CrossrefPubMedSearch in Google Scholar
  • 32 Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila F. et al. Meta-analysis: antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding – an updated Cochrane review. Aliment Pharmacol Ther 34: 509-518
    PubMed
  • 33 Fernandez J, Navasa M, Planas R. et al. Primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis. Gastroenterology 2007; 133: 818-824
    CrossrefPubMedSearch in Google Scholar
  • 34 Bruns T, Stallmach A. Spontaneous and Secondary Bacterial Peritonitis in Cirrhotic Patients with Ascites. Zentralbl Chir 2011
    Thieme ConnectPubMed
  • 35 Appenrodt B, Grunhage F, Gentemann MG. et al. Nucleotide-binding oligomerization domain containing 2 (NOD2) variants are genetic risk factors for death and spontaneous bacterial peritonitis in liver cirrhosis. Hepatology 2010; 51: 1327-1333
    CrossrefPubMedSearch in Google Scholar
  • 36 Bruns T, Peter J, Reuken PA. et al. NOD2 gene variants are a risk factor for culture-positive spontaneous bacterial peritonitis and monomicrobial bacterascites in cirrhosis. Liver Int 2012; 32: 223-230
    CrossrefPubMedSearch in Google Scholar
  • 37 Bruns T, Reuken PA, Fischer J. et al. Further evidence for the relevance of TLR2 gene variants in spontaneous bacterial peritonitis. J Hepatol 2012; 56: 1207-1208 ; author reply 1208-1209
    CrossrefPubMedSearch in Google Scholar
  • 38 Nischalke HD, Berger C, Aldenhoff K. et al. Toll-like receptor (TLR) 2 promoter and intron 2 polymorphisms are associated with increased risk for spontaneous bacterial peritonitis in liver cirrhosis. J Hepatol 55: 1010-1016
    PubMed
  • 39 Paul M, Silbiger I, Grozinsky S. et al. Beta lactam antibiotic monotherapy versus beta lactam-aminoglycoside antibiotic combination therapy for sepsis. Cochrane Database Syst Rev 2006: CD003344
    PubMed
  • 40 Kujath P, Rodloff AC. Peritonitis. 2. Aufl. Heidelberg: Uni-med Verlag; 2005
    Search in Google Scholar
  • 41 Weigelt JA. Empiric treatment options in the management of complicated intra-abdominal infections. Cleve Clin J Med 2007; 74 (Suppl. 04) S29-S37
    PubMedSearch in Google Scholar
  • 42 Bassetti M, Nicolini L, Repetto E. et al. Tigecycline use in serious nosocomial infections: a drug use evaluation. BMC Infect Dis 2010; 10: 287
    PubMedSearch in Google Scholar
  • 43 Eckmann C, Heizmann WR, Leitner E. et al. Prospective, non-interventional, multi-centre trial of tigecycline in the treatment of severely ill patients with complicated infections: new insights into clinical results and treatment practice. Chemotherapy 2010; 57: 275-284
    PubMedSearch in Google Scholar
  • 44 Takesue Y, Nakajima K, Ichiki K. et al. Impact of a hospital-wide programme of heterogeneous antibiotic use on the development of antibiotic-resistant Gram-negative bacteria. J Hosp Infect 2010; 75: 28-32
    CrossrefPubMedSearch in Google Scholar
  • 45 Kollef MH. Is antibiotic cycling the answer to preventing the emergence of bacterial resistance in the intensive care unit?. Clin Infect Dis 2006; 43 (Suppl. 02) S82-S88
    CrossrefPubMedSearch in Google Scholar
  • 46 Sarraf-Yazdi S, Sharpe M, Bennett KM. et al. A 9-Year retrospective review of antibiotic cycling in a surgical intensive care unit. The Journal of surgical research 2012; 176: e73-e78
    CrossrefPubMedSearch in Google Scholar
  • 47 Steinberg DM, Cooke WT, Alexander-Williams J. Free perforation in Crohn’s disease. Gut 1973; 14: 187-190
    CrossrefPubMedSearch in Google Scholar
  • 48 Nagler SM, Poticha SM. Intraabdominal abscess in regional enteritis. Am J Surg 1979; 137: 350-354
    CrossrefPubMedSearch in Google Scholar
  • 49 Keighley MR, Eastwood D, Ambrose NS. et al. Incidence and microbiology of abdominal and pelvic abscess in Crohn’s disease. Gastroenterology 1982; 83: 1271-1275
    PubMedSearch in Google Scholar
  • 50 Gervais DA, Hahn PF, O’Neill MJ. et al. Percutaneous abscess drainage in Crohn disease: technical success and short- and long-term outcomes during 14 years. Radiology 2002; 222: 645-651
    CrossrefPubMedSearch in Google Scholar
  • 51 Lee H, Kim YH, Kim JH. et al. Nonsurgical treatment of abdominal or pelvic abscess in consecutive patients with Crohn’s disease. Dig Liver Dis 2006; 38: 659-664
    CrossrefPubMedSearch in Google Scholar
  • 52 Garcia JC, Persky SE, Bonis PA. et al. Abscesses in Crohn’s disease: outcome of medical versus surgical treatment. J Clin Gastroenterol 2001; 32: 409-412
    CrossrefPubMedSearch in Google Scholar
  • 53 Kim H, Park D, Sohn CI. Comparison of clinical outcomes between the patients with biliary tract infection caused by extend-spectrum beta-lactamase producing and non-producing Klebsielle pneumoniae and Escherichia coli (abstract). Gastroenterology 2011; 140: S-393-S-394
    CrossrefPubMedSearch in Google Scholar
  • 54 Neubrand M, Sackmann M, Caspary WF. et al. Guidelines by the German Society of Digestive and Metabolic Diseases for treatment of gallstones. German Society of Digestive and Metabolic Diseases. Z Gastroenterol 2000; 38: 449-468
    Thieme ConnectPubMedSearch in Google Scholar
  • 55 Attili AF, De Santis A, Capri R. et al. The natural history of gallstones: the GREPCO experience. The GREPCO Group. Hepatology 1995; 21: 655-660
    PubMedSearch in Google Scholar
  • 56 Wada K, Takada T, Kawarada Y. et al. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14: 52-58
    CrossrefPubMedSearch in Google Scholar
  • 57 Miura F, Takada T, Kawarada Y. et al. Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14: 27-34
    CrossrefPubMedSearch in Google Scholar
  • 58 Sharma BC, Agarwal DK, Baijal SS. et al. Endoscopic management of acute calculous cholangitis. J Gastroenterol Hepatol 1997; 12: 874-876
    CrossrefPubMedSearch in Google Scholar
  • 59 Leung JW, Ling TK, Chan RC. et al. Antibiotics, biliary sepsis, and bile duct stones. Gastrointest Endosc 1994; 40: 716-721
    PubMedSearch in Google Scholar
  • 60 Kaya M, Bestas R, Bacalan F. et al. Microbial profile and antibiotic sensitivity pattern in bile cultures from endoscopic retrograde cholangiography patients. World J Gastroenterol 2012; 18: 3585-3589
    CrossrefPubMedSearch in Google Scholar
  • 61 Silen W, Wertheimer M, Kirshenbaum G. Bacterial contamination of the biliary tree after choledochostomy. American journal of surgery 1978; 135: 325-327
    CrossrefPubMedSearch in Google Scholar
  • 62 Lee CC, Chang IJ, Lai YC. et al. Epidemiology and prognostic determinants of patients with bacteremic cholecystitis or cholangitis. Am J Gastroenterol 2007; 102: 563-569
    CrossrefPubMedSearch in Google Scholar
  • 63 Negm AA, Schott A, Vonberg RP. et al. Routine bile collection for microbiological analysis during cholangiography and its impact on the management of cholangitis. Gastrointest Endosc 2010; 72: 284-291
    CrossrefPubMedSearch in Google Scholar
  • 64 Karpel E, Madej A, Buldak L. et al. Bile bacterial flora and its in vitro resistance pattern in patients with acute cholangitis resulting from choledocholithiasis. Scand J Gastroenterol 2011; 46: 925-930
    CrossrefPubMedSearch in Google Scholar
  • 65 Lode H. Microbiological and clinical aspects of aspiration pneumonia. J Antimicrob Chemother 1988; 21 Suppl C: 83-90
    CrossrefPubMedSearch in Google Scholar
  • 66 Lenz P, Conrad B, Kucharzik T. et al. Prevalence, associations, and trends of biliary-tract candidiasis: a prospective observational study. Gastrointest Endosc 2009; 70: 480-487
    CrossrefPubMedSearch in Google Scholar
  • 67 van Lent AU, Bartelsman JF, Tytgat GN. et al. Duration of antibiotic therapy for cholangitis after successful endoscopic drainage of the biliary tract. Gastrointest Endosc 2002; 55: 518-522
    CrossrefPubMedSearch in Google Scholar
  • 68 Stallmach A, Carstens O. Role of infections in the manifestation or reactivation of inflammatory bowel diseases. Inflamm Bowel Dis 2002; 8: 213-218
    CrossrefPubMedSearch in Google Scholar
  • 69 Khanna S, Pardi DS. IBD: Poor outcomes after Clostridium difficile infection in IBD. Nat Rev Gastroenterol Hepatol 2012; 9: 307-308
    CrossrefPubMedSearch in Google Scholar
  • 70 Bauer MP, Kuijper EJ, van Dissel JT. European Society of Clinical Microbiology and Infectious Diseases (ESCMID): treatment guidance document for Clostridium difficile infection (CDI). Clin Microbiol Infect 2009; 15: 1067-1079
    CrossrefPubMedSearch in Google Scholar
  • 71 Binion DG. Strategies for management of Clostridium difficile infection in immunosuppressed patients. Gastroenterol Hepatol 2011; 7: 750-752
    PubMedSearch in Google Scholar
  • 72 Gerding DN, Muto CA, Owens Jr RC. Treatment of Clostridium difficile infection. Clin Infect Dis 2008; 46 (Suppl. 01) S32-S42
    CrossrefPubMedSearch in Google Scholar
  • 73 Ben-Horin S, Margalit M, Bossuyt P. et al. Combination immunomodulator and antibiotic treatment in patients with inflammatory bowel disease and clostridium difficile infection. Clin Gastroenterol Hepatol 2009; 7: 981-987
    CrossrefPubMedSearch in Google Scholar
  • 74 Ingle M, Deshmukh A, Desai D. et al. Prevalence and clinical course of Clostridium difficile infection in a tertiary-care hospital: a retrospective analysis. Indian J Gastroenterol 2011 30: 89-93
    PubMed
  • 75 Collini PJ, Bauer M, Kuijper E. et al. Clostridium difficile infection in HIV-seropositive individuals and transplant recipients. J Infect 2012; 64: 131-147
    CrossrefPubMedSearch in Google Scholar
  • 76 Bossuyt P, Verhaegen J, Van Assche G. et al. Increasing incidence of Clostridium difficile-associated diarrhea in inflammatory bowel disease. J Crohns Colitis 2009; 3: 4-7
    CrossrefPubMedSearch in Google Scholar
  • 77 van Nood E, Vrieze A, Nieuwdorp M. et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med 2013; 368: 407-415
    CrossrefPubMedSearch in Google Scholar
  • 78 Mattila E, Arkkila P, Mattila PS. et al. Rifaximin in the treatment of recurrent Clostridium difficile infection. Alimentary pharmacology & therapeutics 2013; 37: 122-128
    CrossrefPubMedSearch in Google Scholar
  • 79 Lancaster JW, Matthews SJ. Fidaxomicin: the newest addition to the armamentarium against Clostridium difficile infections. Clin Ther 2012; 34: 1-13
    CrossrefPubMedSearch in Google Scholar
  • 80 Blot S, De Waele JJ, Vogelaers D. Essentials for selecting antimicrobial therapy for intra-abdominal infections. Drugs 2012; 72: e17-e32
    CrossrefPubMedSearch in Google Scholar