Progress in medical management of intra-abdominal infection.

PURPOSE OF REVIEW: Intra-abdominal infection management remains debated and evidence-based recommendations are often lacking despite numerous studies. These controversies are mainly explained by the limited number of powered and well designed randomized controlled trials. This review focuses on recent studies on antibiotic therapy for intra-abdominal infections and in particular for the management of severe acute pancreatitis. RECENT FINDINGS: For community-acquired intra-abdominal infection, early source control and antibiotic selection are well codified. In severe forms, every hour of delay between shock and antibiotherapy initiation reduces hospital survival. Antibiotics dose adjustment and continuous intravenous administration are suggested in critically ill patients and for difficult-to-treat pathogens. Shorter antibiotic treatment duration seems to offer similar clinical cure rates compared with prolonged therapy and could reduce emergence of resistance. For multidrug-resistant bacteria, the newly developed agents indications need to be better defined. In severe acute pancreatitis, antibiotic prophylaxis does not prevent necrosis infection nor does it reduce surgery requirement or mortality. Antibiotics should be given on demand. Infectious complications in pancreatitis are not reduced by probiotic prophylaxis and mortality is increased. SUMMARY: There is a growing evidence to support early, dose-adjusted, antimicrobial therapy in severe intra-abdominal infection, together with shorter treatment duration if source control is achieved. This could reduce emergence of resistance without affecting clinical cure rates. In severe acute necrotizing pancreatitis, antibiotic and probiotic prophylaxis to reduce infection or mortality should be avoided.