Expert opinion on pharmacotherapy · 2026
Current advances in pharmacotherapeutic strategies for the treatment of complicated intra-abdominal infections.
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Montravers Philippe, Atchade Enora, Zappella Nathalie
Аннотация
INTRODUCTION: Complicated intra-abdominal infections (cIAIs) represent a major cause of surgical emergencies, arising from community-acquired conditions or heathcare-associated complications. This review, based on literature through 03/2026, from the PubMed (pubmed.ncbi.nlm.nih.gov/) and SMART (globalsmartsite.com) websites, explores strategies for implementing adequate anti-infective therapy in cIAIs.
AREAS COVERED: cIAIs typically involve polymicrobial infections, including aerobic/anaerobic bacteria, and fungi. The rise of multidrug resistance, particularly among Gram-negative microorganisms such as extended-spectrum ß-lactamase-producing Enterobacterales and carbapenem-resistant strains, as well as Gram-positive cocci poses significant challenges. While newer antimicrobial agents show promise, further real-world validation is needed. Pharmacokinetic challenges, including altered drug distribution in peritoneal fluids, and the need for prolonged infusions, highlight the importance of personalized dosing strategies. The role of fungi remains debated, with echinocandins recommended for severe cases, though resistance monitoring is essential.
EXPERT OPINION: Advances in rapid diagnostics, novel anti-infective agents, and pharmacokinetic strategies have improved cIAIs outcomes. However, critical gaps persist. A key priority is to refine pharmacokinetic modeling and expand therapeutic drug monitoring to ensure optimal exposure at infection sites and reduce underdosing risks in diverse patient populations. Global resistance surveillance, interdisciplinary collaboration, and innovative therapies are equally urgent to address the evolving epidemiological and therapeutic challenges in cIAIs.
AREAS COVERED: cIAIs typically involve polymicrobial infections, including aerobic/anaerobic bacteria, and fungi. The rise of multidrug resistance, particularly among Gram-negative microorganisms such as extended-spectrum ß-lactamase-producing Enterobacterales and carbapenem-resistant strains, as well as Gram-positive cocci poses significant challenges. While newer antimicrobial agents show promise, further real-world validation is needed. Pharmacokinetic challenges, including altered drug distribution in peritoneal fluids, and the need for prolonged infusions, highlight the importance of personalized dosing strategies. The role of fungi remains debated, with echinocandins recommended for severe cases, though resistance monitoring is essential.
EXPERT OPINION: Advances in rapid diagnostics, novel anti-infective agents, and pharmacokinetic strategies have improved cIAIs outcomes. However, critical gaps persist. A key priority is to refine pharmacokinetic modeling and expand therapeutic drug monitoring to ensure optimal exposure at infection sites and reduce underdosing risks in diverse patient populations. Global resistance surveillance, interdisciplinary collaboration, and innovative therapies are equally urgent to address the evolving epidemiological and therapeutic challenges in cIAIs.