Anaerobic infection therapy.

Anaerobes are involved mainly in abdominal surgical infections and the Bacteroides fragilis group is still predominant in such infections. By definition surgery itself plays the major role in therapy while antibiotics have an adjunctive role. Depending on the source of the infection, several combinations of either an older cephalosporin for community acquired infections or a more advanced cephalosporin, an aminoglycoside, aztreonam or a quinolone with metronidazole or clindamycin for nosocomial infections, are acceptable therapeutic regimens. Cefoxitin, cefotetan, carbapenems and the inhibitors may also be used as monotherapy. However whenever selecting an antibiotic to combat anaerobes the following points should be seriously considered. The value of anaerobic cultures which should always be obtained in order to be used for local resistance surveillance. There is a lack of important newer antimicrobials active against anaerobes. Studies of newer antibiotics generally exclude critically ill patients and are chiefly made up of appendicitis cases which by definition end up with >90% cure rate. The importance of hyperbaric oxygen in selected cases should be considered.