Intra-abdominal infections are generally supported by various pathogen agents and so need a very wide-range antibiotic cover. But now new chinolonics are available, presenting a very wide antibacterial action, so a blind, randomized study, sponsored by pharmaceutical industry, was performed, examining patients with intra-abdominal infections (above all appendicitis and abscesses) waiting for surgery or transcutaneous drainage. Patients were treated with moxifloxacin i.v. or piperacillin-tazobactam. Patients treated with moxifloxacin i.v. have continued the treatment with the same oral antibiotic, while those initially treated with piperacillin-tazobactam have then passed to amoxicillin-clavulanate. The long exclusion list included gynaecological infections, pancreatitis, intestinal necrosis, peritoneal catheterism and all forms of immunodepressions. In 379 examined patients, recovery at 2 weeks obtained through antibiotic therapy and surgery were similar (80%); in 15% of patients with hospital-acquired infections, there were more recoveries with moxifloxacin (82% vs 55%). Side reactions, including those needing an antibiotic discontinuation, presented the same frequency in the two treatment groups.
Differently from other chinolonics, moxifloxacin has a range covering also various anaerobes, so it can be proposed as an only drug in intra-abdominal infections, if there are no contraindications. The study does not tell if the adding of metronidazole (as suggested by guidelines) can further improve results.
