Table 3.
Suggested antibiotic regimens for treating community- and hospital-acquired IAIs in the Asian region.
| Type of therapy |
||||
|---|---|---|---|---|
| Monotherapy |
Combination therapy |
|||
| Drug of choice | Alternativea | Drugs of choice | Alternativea | |
| Community-acquired cIAI | ||||
| Mild to moderate | Amoxicillin/clavulanate | Moxifloxacinb | Cefazolin, cefuroxime, ceftriaxone or cefotaxime + metronidazole | Levofloxacin + metronidazole Ciprofloxacin + metronidazoleb |
| Severe | Amoxicillin/clavulanate | Moxifloxacinb Ertapenem or tigecyclinec Meropenem, imipeneme/cilastin, doripenem, piperacillin/tazobactamd |
Cefazolin, cefuroxime, ceftriaxone, ceftazidime, cefepime or cefotaxime + metronidazole | Levofloxacin + metronidazole Ciprofloxacin + metronidazoleb |
| Healthcare-associated cIAI | ||||
| Mild to moderate | Meropenem, imipenem, imipenem/cilastin, doripenem or piperacillin/tazobactam [8] | Tigecycline, moxifloxacin, ertapenemf | Cefepime or levofloxacin/ciprofloxacing + metronidazole | |
| Severej | Meropenem, imipenem/cilastin or doripenem | Meropenem, imipenem/cilastin or doripenem + vancomycin or linezolidh Tigecycline + aztreonam/ciprofloxacin/levofloxacin |
Tigecycline + levofloxacin or ciprofloxacinh Carbapenem, tigecycline, polymixin B or colistin ± aminoglycosidei Carbapenem + tigecycline, polymixin B or colistink |
|
Alternative therapy includes the following considerations: allergy, pharmacology/pharmacokinetics, compliance, costs, and local resistance profiles.
Use in cases of β-lactam allergy.
Alternative to cephalosporin or quinolone monotherapy, if the prevalence of community-acquired ESBL+ or quinolone-resistant E. coli is >20%.
Reserve these antipseudomonal regimens for use in patients with neutropenia, septic shock or who are critically ill.
Use imipenem with caution where there is a high prevalence of increased imipenem MICs in Enterobacteriaceae.
Risk groups for P. aeruginosa include patients with neutropenia, septic shock or an indwelling central venous catheter [28].
If hospital-acquired ESBL prevalence is >20%, use the carbapenems preferentially over piperacillin/tazobactam, cefepime, ceftazidime or levofloxacin.
Use if both hospital-acquired ESBL and MRSA prevalence rates are >20%.
Use for suspected pseudomonal or Acinetobacter infections with reduced susceptibility (tigecycline only for Acinetobacter).
Antifungal therapy may be required in selected circumstances as advised in current IDSA guidelines.
Use if carbapenemases (e.g., NDM and KPC) with extended resistance to currently available antibiotics are suspected; also seek expert advice.