Age is a major factor in determining the outcome for older patients with intra-abdominal
sepsis. Poor outcome in these patients may be related to a number of physiologic and immunologic changes associated with aging. The treatment of intra-abdominal
sepsis can itself pose special risks for the elderly. Standard regimens containing
aminoglycosides have a substantial risk of nephrotoxicity, which is magnified in elderly patients. Alternatives to standard
aminoglycoside-containing regimens, therefore, are desirable. Most
intra-abdominal infections involve multiple pathogens, usually both aerobic and anaerobic. The polymicrobial nature of intra-abdominal
sepsis mandates antimicrobial
chemotherapy effective against a broad range of organisms. In the past several years, a host of new
antibiotics have been introduced that used alone or in combination with other drugs has the potential of safely avoiding
aminoglycosides in many patients with intra-abdominal
sepsis. One such agent,
ticarcillin with
clavulanate potassium, is active against a wide spectrum of aerobic and anaerobic pathogens. In a prospective, randomized, open label trial,
ticarcillin and
clavulanate was compared with
gentamicin and
clindamycin. Although the sample size was too small to allow meaningful statistical comparisons of efficacy and safety, both regimens were effective and well tolerated. In general, prolonged administration of
aminoglycosides is rarely indicated for the treatment of intra-abdominal
sepsis in the elderly, although initial empiric use of
aminoglycosides may sometimes be warranted.