Emerging treatments
Endoscopic ultrasound-guided drainage
Endoscopic ultrasound-guided drainage has been suggested for internal drainage of IAAs, such as pancreatic abscesses. Other potentially accessible areas include the pelvis and perirectal space, and the subphrenic and perihepatic spaces. However, the technique has not been rigorously compared with percutaneous drainage, and risks include severe bleeding and perforation. Endoscopic ultrasound requires specialized expertise; data regarding its safety and effectiveness in draining IAA are preliminary. However, endoscopic ultrasound may be useful in critically ill patients requiring bedside procedures or for IAA not amenable to other conventional therapies. The experience remains limited to case reports; however, interest persists.[26][57]
Eravacycline
Eravacycline, an intravenous fluorcycline antibiotic (in the tetracycline class of antibiotics), has been approved by the Food and Drug Administration and the European Medicines Agency for adults with complicated intra-abdominal infections that involve the following organisms: Escherichia coli, Klebsiella pneumoniae, Citrobacter freundii, Enterobacter cloacae, Klebsiella oxytoca, Enterococcus faecalis, Enterococcus faecium, Staphylococcus aureus, Streptococcus anginosus group, Clostridium perfringens, Bacteroides species, and Parabacteroides distasonis. Eravacycline has shown activity against organisms that express tetracycline-specific resistance mechanisms. Like other tetracycline antibiotics, it may cause discoloration of deciduous teeth.
Meropenem/vaborbactam
Meropenem/vaborbactam is a fixed combination intravenous antibiotic containing meropenem (an antibiotic in the carbapenem class of antibiotics) and vaborbactam (a beta-lactamase inhibitor). The European Medicines Agency has approved the drug to treat complicated intra-abdominal infections. The approval provides an option for organisms that are resistant to carbapenem antibiotics, which has been increasing recently, particularly in gram-negative bacteria. Meropenem/vaborbactam is available in the US, but is currently approved only for the treatment of complicated urinary tract infections.
Imipenem/cilastatin/relebactam
Imipenem/cilastatin/relebactam is a fixed combination intravenous antibiotic containing imipenem (an antibiotic in the carbapenem class of antibiotics), cilastatin (a renal dihydropeptidase inhibitor, which reduces the nephrotoxicity associated with imipenem and has no antimicrobial activity), and relebactam (a beta-lactamase inhibitor). The Food and Drug Administration has approved this drug to treat adults with complicated intra-abdominal infection when there are limited or no alternative antibacterial drugs available to treat the infection. It is not available in Europe as yet.
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