Note on use of antimicrobial agents with Anaerobic coverage:
Antimicrobial drugs with anaerobic activity:
- Amoxicillin-clavulanate
- Ampicillin-sulbactam
- Cefoperazone-sulbactam
- Clindamycin*
- Doripenem
- Ertapenem
- Imipenem
- Meropenem
- Metronidazole
- Piperacillin-tazobactam
- Ticarcillin-clavulanate
- Tigecycline
Points to consider while using antimicrobial agents with anaerobic activity:
- The combined use of two antimicrobials with anaerobic cover mentioned above is unnecessary and should be avoided to prevent additional toxicity.
-
Exceptions to (1) are:
- Clostridioides difficile infection
- Amoebic colitis or Amoebic liver abscess
*- Clindamycin:
Not active against Gram –negative anaerobes, so should not be used for infections where Gram-negative anaerobes are suspected (eg: intra-abdominal infections)
References
1. Implementation of Antibiotic Stewardship Core Elements at Small and Critical Access Hospitals. Centers for Disease Control and Prevention, www.cdc.gov/antibiotic- use/healthcare/implementation/core-elements-small-critical.html.
2. Core Elements of Hospital Antibiotic Stewardship Programs. Centers for Disease Control and Prevention, www.cdc.gov/antibiotic-use/healthcare/implementation/core-elements.html
3. Huttner B, Jones M, Rubin MA, et al. Double trouble: how big a problem is redundant anaerobic antibiotic coverage in Veterans Affairs medical centers. J Antimicrob Chemother. 2012;67(6):1537-9.