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Diverticula are small mucosal herniations protruding through the intestinal layers and the smooth muscle along the natural openings created by the vasa recta or nutrient vessels in the wall of the colon. These herniations create small pouches lined solely by mucosa. Diverticula can occur anywhere in the gastrointestinal tract but are usually observed in the colon. The sigmoid colon has the highest intraluminal pressures and is most commonly affected. Diverticulosis is defined as the condition of having uninflamed diverticula. The cause of diverticulosis is not yet conclusive, but it appears to be associated with a low-fiber diet, constipation, and obesity. Diverticulitis is defined as an inflammation of one or more diverticula. Its pathogenesis remains unclear. Fecal material or undigested food particles may collect in a diverticulum, causing obstruction. This obstruction may result in distension of the diverticula secondary to mucous secretion and overgrowth of normal colonic bacteria. Vascular compromise and subsequent microperforation or macroperforation then ensue. Alternatively, some believe that increased intraluminal pressure or inspissated food particles cause erosion of the diverticular wall, resulting in inflammation, focal necrosis, and perforation. The disease is frequently mild when pericolic fat and mesentery wall off a small perforation. However, larger perforations and more extensive disease lead to abscess formation and, rarely, intestinal rupture or peritonitis. Fistula formation is a complication of diverticulitis. Fistulas to adjacent organs and the skin may develop, especially in the presence of an abscess. In men, colovesicular fistulas are the most common. In women, the uterus is interposed between the colon and the bladder, and this complication is only seen following a hysterectomy. The uterus precludes fistula formation from the sigmoid colon to the urinary bladder. However, colovaginal and colocutaneous fistulas can form but are uncommon. Recurrent attacks of diverticulitis can result in the formation of scar tissue, leading to narrowing and obstruction of the colonic lumen.
United States Asymptomatic diverticulosis is a common condition. The incidence of diverticulosis increases with age, from less than 5% before age 40 years to greater than 65% by age 85 years. Diverticulitis appears to be more common in patients with the largest number of diverticula; 1520% of those with diverticulosis develop diverticulitis. While diverticulitis is generally considered a disease of the elderly population, as many as 20% of patients with diverticulitis are younger than 50 years.
80-85% remain asymptomatic. Asians. Left-sided diverticula predominate in the United States. Race Genetics are believed to play a role. reaching a prevalence of greater than 65% in those older than 85 years. For unclear reasons. after adopting a more Western lifestyle.International Diverticulosis occurs more frequently in Western countries and industrialized societies. These complications include abscess formation. accounting for as many as 75% of cases of diverticulitis in that group. in patients with significant comorbid conditions. 15-25% of those with diverticulitis develop complications leading to surgery. The reason is unclear but presumably secondary to lifestyle and dietary factors. These morbidity and mortality data. Of these patients with complicated diverticulitis. The rate of surgery in these patients was 8% at 7 years and rose to 14% by 13 years. Diverticulitis may be a more severe illness in patients who are immunocompromised. and in those taking anti-inflammatory medications. do not receive surgery) have a recurrence rate of 20-35%. peritonitis. As it is less common in underdeveloped countries. including Asian Americans. The mean age at presentation with diverticulitis appears to be about 60 years. Another study of 337 patients hospitalized for complicated diverticulitis revealed an association of perforation and mortality in those with no prior history of diverticulitis. and fistula formation. have a predominance of right-sided diverticula. . Mortality/Morbidity Of patients with diverticulosis. 53% presented on a first event. a recurrence rate of 50% was reported after 7 years. y y y y Patients with diverticulitis who are managed conservatively (ie. diverticulitis is also less common. Age Diverticular disease increases in incidence with age. in addition to dietary factors. The mortality rate from complications in patients with recurrent disease in this small study was 1%. Recurrence rates after surgical resection range from 1-3%. intestinal rupture. are based on a retrospective review of relatively short-term data. as well as recurrence rates. right-sided disease is more common in Asian people. Sex Prevalence is similar in men and women. In fact. In one study of 252 patients. the prevalence of diverticulosis has increased in Japan. Approximately 5% develop diverticulitis.
pelvic. Left lower quadrant pain is the most common presenting complaint and occurs in 70% of patients. Right lower quadrant tenderness.History The clinical presentation of diverticulitis depends on the location of the affected diverticulum. Diverticulitis in the transverse colon may mimic peptic ulcer disease. Retroperitoneal involvement may present similar to renal disease. diverticulitis can develop anywhere in the gastrointestinal tract. symptoms may mimic multiple conditions. mirroring the severity of the inflammation and the presence of complications. the pain is localized and severe and present for several days prior to presentation. and frequency. hence. More severe diverticulitis is often accompanied by anorexia. Macroperforation with spillage of colonic contents into the peritoneum leads to generalized abdominal pain and peritonitis. a tender palpable mass may be felt on physical examination. disease may progress from a localized and walled-off process to one with peridiverticular inflammatory phlegmon and localized abscess. lower quadrant pain may be difficult to distinguish from a gynecological process. y y y y Diverticulitis in the right colon or in a redundant sigmoid colon may be mistaken for acute appendicitis. In women. Leg pain possibly associated with a thigh abscess and leg emphysema secondary to retroperitoneal perforation from diverticulitis have been reported. In complicated diverticulitis with abscess formation. y y In simple diverticulitis. Physical Diverticulitis can present with a range of physical findings. constipation. especially constipation. On the other hand. The . or rectal examination. nausea. Symptoms of mild diverticulitis may be confused with overlapping symptoms of irritable bowel syndrome. Altered bowel habits. are reported by most patients. fever) then develop. In fact. due to inflammation adjacent to urinary tract structures. and bloating. Because diverticula and. Pain is often described as crampy and may be associated with a change in bowel habits. may present with no systemic signs of illness or infection. Peritonitis due to free perforation results in generalized tenderness with rebound and guarding on abdominal examination. mimicking acute appendicitis. the severity of the inflammatory process. Other symptoms include nausea and vomiting. urgency. 20% of cases present with a palpable mass on abdominal. and the presence of complications. localized abdominal tenderness in the area of the affected diverticula and fever are common findings. can occur in right-sided diverticulitis. A microperforation. A small percentage of patients may complain of urinary symptoms. such as dysuria. or cholecystitis. Typically. Systemic signs of infection (eg. flatulence. pancreatitis. as most diverticula occur in the sigmoid colon. and vomiting. diarrhea. most likely walled off by adjacent structures. Left lower quadrant tenderness is the most common physical finding.
Renal function is assessed prior to the administration of most intravenous contrast material. o CT scans are preferred over intraluminal examinations (eg. Colovesicular fistulas may present with urinary tract symptoms. A urine culture may confirm sterile pyuria due to inflammation versus polymicrobial infection in the case of a fistula. indicating infection.y y abdomen may be distended and tympanic to percussion. Fecaluria can also be observed. CT scans can help assess disease . Laboratory tests may be of help when the diagnosis is in question. since the bulk of inflammation is extraluminal. However. If a fistula forms. This is particularly true in patients who are immunocompromised. A pregnancy test must be performed in any female of childbearing age who presents with abdominal pain to rule out ectopic pregnancy. as 20-40% of patients have a normal white blood cell count. Causes See Pathophysiology. inflammation and infection due to diverticulitis adjacent to the ureters or the bladder may be the source of the cells. Elderly patients and some patients taking corticosteroids may have unremarkable findings on physical examination even in the presence of severe diverticulitis. Imaging Studies y The diagnosis of diverticulitis can be made on clinical grounds. urinalysis may reveal red or white blood cells. or costovertebral angle tenderness. Bowel sounds can be diminished or absent. If a colovesicular fistula is suspected. but a CT scan of the abdomen is considered the best imaging method to confirm the diagnosis. Female patients with colovaginal fistulas may present with a purulent vaginal discharge. Blood cultures should be obtained prior to the administration of empiric parenteral antimicrobial therapy in patients who are severely ill or in those with complicated disease. in elderly patients. barium enema). However. Such patients must be approached with a high index of suspicion to avoid a delay in establishing the correct diagnosis. such as suprapubic. the absence of leukocytosis does not rule out diverticulitis. the findings vary depending on the type of fistula. and in those with less severe disease. as well as prior to radiologic studies and before administering certain antibiotics to protect a viable fetus. A hemogram may reveal leukocytosis and a left shift. Liver tests and lipase may help to exclude other causes of abdominal pain. A hemoglobin level is important when the patient reports hematochezia. flank. Chemistries may be helpful in the patient who is vomiting or has diarrhea to assess electrolyte abnormalities. Laboratory Studies y y y y y y y The diagnosis of acute diverticulitis can usually be made on the basis of history and physical examination.
Large abscess. as follows: y y y y Stage I disease . In the acute setting. often confined to the pelvis Stage III disease . Staging Several staging schemes have been proposed based on clinical findings.Small or confined pericolic or mesenteric abscess Stage II disease .Rupture of diverticula into the peritoneal cavity with fecal contamination causing generalized fecal peritonitis Medical Care The approach to the treatment of diverticulitis can be broadly classified into either uncomplicated disease or complicated disease.y y severity. this can indicate bowel perforation. If free air is present. colonic diverticula. and complicated diverticulitis. soft tissue inflammatory masses. o Possible CT findings include the following: pericolic fat stranding due to inflammation. fistula formation. and the presence of complications.[1. After the diverticulitis has subsided.Perforated diverticulitis causing generalized purulent peritonitis Stage IV disease . with a few other special considerations to take into account. Clinical staging by Hinchey's classification is geared toward choosing the proper surgical procedure when diverticulitis is complicated. can be as high as 97%. It can be used to guide percutaneous drainage of an abscess. Acute uncomplicated diverticulitis is successfully treated in 70-100% of patients with conservative management. the presence of complications. and abscesses. the simplest method is to differentiate among asymptomatic diverticulosis. especially with helical CT and colonic contrast. CT scans are safer than contrast studies. extent on imaging studies. plain abdominal radiograph series with supine and upright films can demonstrate bowel obstruction or ileus. Probably. uncomplicated diverticulitis. 2] . Peritonitis. phlegmon. and clinical staging. Plain radiograph films are not helpful in making the diagnosis of diverticulitis. colonoscopy can be used to evaluate the extent of diverticulosis or to rule out a malignancy masquerading as a benign postinflammatory stricture. A water-soluble contrast should be used. bowel wall thickening. Contrast enema is not the imaging modality of choice during an acute episode of abdominal pain and should only be considered in mild-to-moderate uncomplicated cases of diverticulitis when the diagnosis is in doubt. Sensitivity and specificity. as leakage of barium into the peritoneum would be catastrophic. and obstruction can also be assessed. However. Procedures y Endoscopy is not recommended in the acute setting given the risk of worsening diverticulitis and bowel perforation.
Pain may be severe enough to require parenteral narcotic analgesia. Patients who are unable to tolerate oral hydration. as well as aerobic microorganisms. typically with Hinchey stage I disease. Start broad-spectrum intravenous antibiotic coverage until culture results. Although it is still a reasonable choice. Streptococcus. Moxifloxacin is appropriate monotherapy for outpatient treatment of uncomplicated diverticulitis. o Multiple drug regimens are also appropriate options in the hospital setting and may consist of metronidazole and a third-generation cephalosporin or a fluoroquinolone. ampicillin/sulbactam. Hospitalization is required with evidence of severe diverticulitis. o One typical oral antibiotic regimen is a combination of ciprofloxacin (or trimethoprim-sulfamethoxazole) and metronidazole. Morphine is acceptable for pain control and is preferable over meperidine given the adverse effects associated with meperidine. ticarcillin/clavulanic acid. Use of . cefotaxime. which usually occurs within 23 days. Single and multiple antibiotic regimens are equally effective as long as both groups of organisms are covered. or meropenem. substitution with a third-generation cephalosporin or a fluoroquinolone has been advocated to avoid the risk of aminoglycoside nephrotoxicity. gentamicin was recommended as part of a multiple drug regimen. persistent or increasing fever. o Initiate bowel rest and intravenous fluid hydration. such as diabetes and renal failure. or levofloxacin.y y y Acute diverticulitis tends to be more severe in very elderly people and in patients who are immunocompromised or who have debilitating comorbid conditions. such as Bacteroides fragilis and Peptostreptococcus and Clostridium organisms . o Pain management is important. pain. tigecycline is a good choice for monotherapy. Such antibiotics include the following: ceftriaxone. such as Escherichia coli and Klebsiella. o Patients should be instructed to be on a clear liquid diet only and can advance the diet slowly as tolerated after clinical improvement. Amoxicillin/clavulanic acid monotherapy is acceptable as well. which covers anaerobic microorganisms. o When severe penicillin allergy is a concern. Proteus. ciprofloxacin. Although early recommendations for pain management favored meperidine based on a theoretical risk of affecting bowel tone and sphincters. are available. or who have comorbidities may also require hospitalization. o Monotherapy with beta-lactamase inhibiting antibiotics or carbapenems provides broad antibacterial coverage and is appropriate for patients who are moderately ill and require admission. imipenem. o For patients who are immunocompromised. if obtained. imipenem or meropenem may be preferred over ertapenem for better enterococcal and pseudomonal coverage. Patients with mild diverticulitis. who fail outpatient therapy (ie. and Enterobacter organisms. randomized prospective studies comparing the narcotic options are not available. who are immunocompromised. can be started on an outpatient treatment regimen. or leukocytosis after 2-3 d). Previously. such as systemic signs of infection or peritonitis. Such antibiotics include the following: piperacillin/tazobactam. This consists of a clear liquid diet and 7-10 days of oral broad-spectrum antimicrobial therapy.
pain. o Within 2-3 days of hospitalization. the patient's fever. o For abscess cavities containing gross fecal material or when there is perforation. the patient may advance diet as tolerated and then maintain a lifelong high-fiber diet. alternatively. and leukocytosis. and leukocytosis should begin to resolve.y nonsteroidal anti-inflammatory drugs and corticosteroids have been associated with a greater risk of colon perforation and should be avoided whenever possible. the patient can be discharged to complete a 7. Colonoscopy or. The patient can then be started on a clear liquid diet and advanced as tolerated. fever. a repeat CT scan of the abdomen is advisable to rule out an abdominal abscess or other complications. This usually leads to a prompt (< 72 h) reduction in pain. a CT±guided percutaneous drainage is indicated. barium enema with flexible sigmoidoscopy should be done after resolution of an initial episode (typically 2-6 wk after recovery) to exclude other diagnoses. Percutaneous drainage is also beneficial in that it may allow for elective surgery rather than emergency surgery and increase the likelihood of a successful 1-stage procedure.to 10-day course of oral antibiotic therapy. data have since called this practice into question when the patient is otherwise healthy. ischemia. o If a patient is found to have a peridiverticular abscess that measures more than 4 cm in diameter (Hinchey stage II disease). . early surgical intervention is required. o If fever and leukocytosis do not resolve after 2-3 days of treatment or if serial examinations reveal worsening signs or new peritoneal findings. y The classic surgical indications include some features characteristic of Hinchey stage III or IV disease and are as follows: o Free-air perforation with fecal peritonitis o Suppurative peritonitis secondary to a ruptured abscess o Uncontrolled sepsis o Abdominal or pelvic abscess (unless CT-guided aspiration is possible) o Fistula formation o Inability to rule out carcinoma o Intestinal obstruction o Failing medical therapy o Immunocompromised status o Extremes of age o Recurrent episodes of acute diverticulitis: Elective surgery was previously recommended in any patient who had 2 or more episodes of diverticulitis that were successfully treated medically. Once the acute episode has resolved. such as cancer. Surgical Care About 15-25% of patients presenting with a first episode of acute diverticulitis have complicated disease that requires surgery. If tolerating oral intake and clinically stable. and inflammatory bowel disease.
which involves resection of the diseased segment of bowel. Also. and proximal diverting stoma. which open up tissue planes to infection and increase blood loss. Other appropriate indications for elective colectomy include inability to exclude carcinoma. Guidelines from the American Society of Colon and Rectal Surgeons (2006) recommend emergency surgery for patients with diffuse peritonitis and for those who fail nonoperative management. The decision to proceed with elective surgery. 4] o An alternative to the Hartmann procedure includes resection of the diseased colon. This decision should consider age and medical condition of the patient. gentamicin. The second procedure in this course would be to close the stoma. and allowing a prolonged period of time to pass between the Hartmann and reversal procedures.[3. are appropriate choices.y y y y Preoperative preparation with antibiotics should be given in all patients. This is the preferred approach in patients with fecal peritonitis and in most cases of purulent peritonitis. having a low preoperative albumin level. Bowel preparation is usually possible for nonemergent situations. offering the operation to appropriately selected patients is acceptable. 3 months later. A 2-stage surgical approach is the most common surgical procedure performed today for the emergency treatment of acute diverticulitis. o Fleming and Gillen also found in the above study that risk factors for reversal complications included being a current smoker. a single drug regimen (with either imipenem/cilastin or piperacillin/tazobactam) or a multiple drug regimen (with ampicillin. patients who are immunosuppressed or immunocompromised are at an increased risk of failing medical therapy or perforation and should be approached with a lower threshold. The advantage is that it avoids the technically difficult second stage used in the Hartmann procedure. and closure of the rectal stump. They also suggested that preoperative identification of modifiable of risk factors may benefit patients. However. have no role. frequency and severity of attacks. an end-colostomy. after an episode . primary anastomosis (with or without intraoperative colonic lavage). however. typically at least 6 weeks after recovery from acute diverticulitis. a second procedure can be performed to close the rectal stump. either colostomy or ileostomy. and the presence of any persistent symptoms after the acute episode. as discussed in Medical Care. and metronidazole) may be warranted for peritonitis. The authors concluded that despite the reversal surgery's significant complication rate. Typically. The authors found that out of 76 reversal patients. should be made on a case-by-case basis. 18 of them (25%) had post-reversal complications. Fleming and Gillen investigated the rate of and risk factors for complications linked to the reversal procedure. for patients with more extensive contamination. this second operation can be technically difficult and is not performed in many patients. o Extensive and unnecessary dissections. This approach is primarily used when there are relative contraindications to primary anastomosis but no purulent or feculent peritonitis and there is nonedematous bowel. o Examining data from patients who had undergone the Hartmann procedure for acute diverticulitis and then (after a median 7-month period) had undergone reversal surgery. o A traditional Hartmann procedure is commonly performed. Single and multiple drug regimens.
Special considerations exist for some forms of complicated diverticulitis. nonedematous. and well prepared. most patients who present with complicated diverticulitis do so at the time of their first episode. Increasing experience with laparoscopic techniques for colon resection suggests that some of its advantages include less pain. This approach is best suited for patients in whom the episode of acute diverticulitis has resolved and in patients with Hinchey stage I or II disease. Not all of the diverticula-bearing colon must be removed. and shorter recovery time. o A 1-stage surgical approach with resection and primary anastomosis is often possible in elective settings since the disease is well localized and/or significantly resolved. There is no change in early or late complications and cost and outcome are comparable to open procedures. Therefore. o In this approach. Drainage is usually through the anterior abdominal wall but may be done transgluteally or through the rectum or the vagina. o Obstruction needs to be differentiated from carcinoma. o Patients with Hinchey stage I or II disease can usually have preoperative bowel preparation. the patient's future episodes are likely to follow a similar course. The proximal margin should be an area of pliable colon without hypertrophy or inflammation. after one attack. resection may be necessary to exclude carcinoma if there is enough suspicion based upon appearance alone. o Regarding severity. a further one third will have yet another attack. performed 2-4 weeks after the second operation. o Regarding frequency. or after percutaneous drainage of a diverticular abscess. since diverticula proximal to the descending or sigmoid colon are unlikely to result in further symptoms. After a second episode. a smaller scar. closes the stoma. The distal margin should extend to the upper third of the rectum where the taenia coalesces. Catheter drainage may be helpful in patients who cannot undergo surgery and should be left in place . The bowel must be well vascularized. depending on the location of the abscess.y y y of complicated diverticulitis treated nonoperatively. o Abscesses without peritonitis may be amenable to percutaneous drainage with an elective single-stage operation after the episode has resolved. and metronidazole. gentamicin. tension free. without resection. o For diffuse peritonitis. o The second operation is performed 2-8 weeks later to resect the diseased bowel and perform a primary anastomosis. about one third of patients will have a later second attack of acute diverticulitis. o A third operation. once a patient's initial presentation has been determined to be uncomplicated or complicated. even if biopsy results are negative. The classic 3-stage surgical approach is now rarely indicated because of high associated morbidity and mortality and is considered only in critical situations in which resection cannot safely be performed. an appropriate initial empiric antibiotic regimen must include either single agent therapy with imipenem/cilastin or piperacillin/tazobactam or multiple drug therapy with ampicillin. the initial operation is simply drainage of the diseased segment and creation of a proximal diversion colostomy. and.
Recommending to patients to avoid seeds and nuts is currently less common. Consultations y y Surgical consultation Gastroenterologic consultation Diet y y y y In mild episodes. but they may be managed with an elective 1-stage procedure in most cases. observation appears safe in patients with contraindications to surgery. Empiric therapy requires broad-spectrum antibiotics effective against known enteric pathogens. Catheter sinograms can be performed periodically to monitor the resolution of the abscess cavity before the catheter is removed. a clear liquid diet is advised. carbapenems are the most effective empiric therapy because of increasing bacterial resistance to other regimens. since it is now thought that seeds and nuts may not play a significant role in the development of diverticulitis. after patients have become symptomatic. the benefit of fiber supplementation is less clear. Also. and the diet can then be advanced as tolerated. o Patients who are immunosuppressed are at an increased risk of perforation. and surgery is necessary in almost all patients who are either already immunosuppressed or are about to start immunosuppressive therapy. Clinical improvement should occur within 2-3 days. For complicated cases of diverticulitis in hospitalized patients. in the absence of urinary tract obstruction. Administer nothing by mouth in episodes of moderate-to-severe acute diverticulitis. Long-term management probably includes a high-fiber. as believed in the past. Antibiotics Class Summary . However. Activity Normal activity is possible after resolution of the acute episode. low-fat diet. Medication Summary Diverticulosis is treated with lifelong dietary modification.until drainage is less than 10 mL in 24 hours. Antibiotics are used for every stage of diverticulitis. o Fistulas generally do not close spontaneously. Studies imply a high-fiber diet will prevent progression of diverticulosis.
base dosing protocol on amoxicillin content. S epidermidis. S aureus (methicillin susceptible). For children >3 months. Has good tissue penetration but does not enter cerebrospinal fluid. causing cell death. Shigella species. E cloacae. View full drug information Metronidazole (Flagyl) Active against various anaerobic bacteria. M catarrhalis. Bactrim DS.Empiric antimicrobial therapy is essential and should cover all pathogens likely to cause diverticulitis. and inhibits protein synthesis. The half-life of oral dosage form is 1-1. View full drug information Ciprofloxacin (Cipro) Bactericidal antibiotic that inhibits bacterial DNA synthesis. S pyogenes. Septra. View full drug information Sulfamethoxazole and Trimethoprim (Bactrim. Campylobacter jejuni. Good alternative antibiotic for patients allergic or intolerant to the macrolide class. H influenzae. Not effective against Mycoplasma and Legionella species.3 h. P mirabilis. Septra DS) . and Salmonella typhi. P vulgaris. S pneumoniae. P aeruginosa. K pneumoniae. do not use 250-mg tab until child weighs >40 kg. Addition of clavulanate inhibits beta-lactamase producing bacteria. Usually is well tolerated and provides good coverage to most infectious agents. Because of different amoxicillin/clavulanic acid ratios in 250-mg tab (250/125) vs 250-mg chewable tab (250/62. View full drug information Amoxicillin/clavulanate (Augmentin) Amoxicillin inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins.5). Used for infections due to E coli. binds DNA. Enters cell.
lower efficacy against gram-positive organisms. except Pseudomonas aeruginosa. Bacteria eventually lyse due to the ongoing activity of cell wall autolytic enzymes while cell wall assembly is arrested. Reversibly binds to human plasma proteins. View full drug information Moxifloxacin (Avelox) . View full drug information Ceftriaxone (Rocephin) Third-generation cephalosporin with broad-spectrum. Exerts antimicrobial effect by interfering with synthesis of peptidoglycan. and remainder secreted in bile and ultimately in feces as microbiologically inactive compounds. Lower efficacy against grampositive organisms. both penicillinase and cephalosporinase. and binding have been reported to decrease from 95% bound at plasma concentrations < 25 mcg/mL to 85% bound at 300 mcg/mL. a major structural component of bacterial cell wall. inhibits bacterial growth. lower efficacy against gram-positive organisms. Third-generation cephalosporin with gram-negative spectrum. View full drug information Cefotaxime (Claforan) Third-generation cephalosporin with broad gram-negative spectrum. which. Antibacterial activity of TMP-SMZ includes common urinary tract pathogens. Bactericidal activity results from inhibiting cell wall synthesis by binding to one or more penicillin binding proteins. higher efficacy against resistant organisms. in turn. gram-negative activity. of gramnegative and gram-positive bacteria.Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Arrests bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins. and higher efficacy against resistant organisms. Highly stable in presence of beta-lactamases. Used for septicemia and treatment of gynecologic infections caused by susceptible organisms. Approximately 33-67% of dose excreted unchanged in urine.
Streptococcus anginosus. Covers skin. exhibits activity against Escherichia coli. Inhibits biosynthesis of cell wall mucopeptide and is effective during stage of active multiplication. Proteus mirabilis. . and anaerobes. causing bactericidal activity against susceptible organisms. Interferes with bacterial cell wall synthesis during active replication. Bacteroides thetaiotaomicron. View full drug information Levofloxacin (Levaquin) For pseudomonal infections and infections due to multidrug resistant gram-negative organisms. Moxifloxacin. Antipseudomonal penicillin and beta-lactamase inhibitor that provides coverage against most gram-positive and gram-negative bacteria and most anaerobes. Moxifloxacin is active against gram-positive organisms and anaerobes but less active against Enterobacteriaceae and Pseudomonas species.Moxifloxacin is the only fluoroquinolone that is FDA approved as monotherapy for the treatment of complicated intra-abdominal infections. or Peptostreptococcus species. Not ideal for nosocomial pathogens. Enterococcus faecalis. Clostridium perfringens. Streptococcus constellatus. View full drug information Ampicillin/Sulbactam (Unasyn) Drug combination of beta-lactamase inhibitor with ampicillin. View full drug information Ticarcillin and clavulanate potassium (Timentin) Inhibits biosynthesis of cell wall mucopeptide and is effective during active replication. a broad-spectrum antibiotic. View full drug information Piperacillin and Tazobactam sodium (Zosyn) Anti-pseudomonal penicillin plus beta-lactamase inhibitor. enteric flora. Bacteroides fragilis. Alternative to amoxicillin when unable to take medication orally.
Effective against most gram-positive and gram-negative bacteria. View full drug information Tigecycline (Tygacil) Tetracycline type antibiotic with broad coverage. adjust dose based on CrCl and changes in volume of distribution. View full drug information Imipenem and cilastatin (Primaxin) Used for treatment of multiple organism infections as in peritonitis when other agents are not appropriate. Drugs of this class are a good choice for empiric therapy of GI-based infections in hospitalized patients with complicated conditions. Dosing regimens are numerous. and in mixed infections caused by susceptible staphylococci and gramnegative organisms. Consider if penicillins or other less toxic drugs are contraindicated. when clinically indicated. FDA approved for complicated intra-abdominal infections. Not the DOC. Has slightly increased activity against gram-negative organisms and slightly decreased activity against staphylococci and streptococci compared with imipenem. used when the patient has a severe penicillin allergy.View full drug information Meropenem (Merrem) Bactericidal broad-spectrum carbapenem antibiotic that inhibits cell-wall synthesis. View full drug information Gentamicin (Gentacidin) Aminoglycoside antibiotic used to cover gram-negative organisms. View full drug information . May be given IV/IM.
causing bactericidal activity against susceptible organisms. . Alternative to amoxicillin when unable to take medication orally. Interferes with bacterial cell wall synthesis during active replication.Ampicillin (Principen) Broad-spectrum penicillin.