Intra abdominal infections are a group of diseases of abdomen and are one of the most common causes of mortalities across the globe. These include peritonitis, intra abdominal abscess, diverticulitis, appendicitis, food poisoning and pelvic inflammatory disease. Post surgical infections are a major cause of intra abdominal infections. The infections can also occur due to inflammatory bowel disease, ruptured appendix, and intestinal infection. Symptoms may vary depending on the anatomical location of infection. Common symptoms include abdominal pain, chills, diarrhea, nausea, lack of appetite, fever, rectal tenderness and vomiting. Initial leakage of the gastrointestinal microflora into the peritoneal cavity results in peritonitis and secondary septicemia, and is usually followed by localized abscess. Severe sepsis is one of the prominent factors increasing mortality rates in intra abdominal infections.
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Intra abdominal infections are most frequently polymicrobial. Major causative agents of intra abdominal infections include E. coli, Streptococci, Enterococci, Klebsiella, Pseudomonas, and H. pylori. The diseases are diagnosed by blood tests, abdominal X-ray, computed tomography (CT) and ultrasound. Due to large number of causative agents involved, poor prognosis and varied symptoms, the disease is difficult to diagnose and treat. Factors influencing the prognosis of complicated intra-abdominal infections include age, immunosuppression, pre-existing diseases, extended peritonitis, occurrence of septic shock, organ failures, and delay in therapy. Broad spectrum antibiotics are the main choice of treatment, but they may also alter the normal gastrointestinal microflora. Following is the list of antibiotics mainly prescribed for intra abdominal infections:
- Anaerobic coverage
- Aerobic coveragee
- Beta lactums
- Beta lactums
Vancomycin is strictly recommended for treatment of proven intra abdominal infection due to Methicillin-resistant Staphylococcus aureus (MRSA) due its serious side effects. Intra abdominal infections can be easily cured if diagnosed and treated in the early stage of infection. There have been cases where drug resistant microbial species have set infections to critical levels. Under such circumstances, surgical methods can be used.
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These methods for treatment of intra abdominal infections include intraoperative peritoneal irrigation with saline, antibiotic solutions, and povidone-iodine. This method is widely used to manage patients with secondary bacterial peritonitis. Complicated intra abdominal infections are an important cause of morbidity and are frequently associated with poor prognosis, making treatment difficult.
Pharmaceutical companies are also trying to discover new drugs for the treatment of intra abdominal infections. Pfizer, Merck Sharp & Dohme Corp. and Tetraphase Pharmaceuticals, Inc. are some of the major companies conducting clinical trials for treatment for intra abdominal infections. As newer drugs receive regulatory approvals, market will expand its scope and grow rapidly. As the market is matured, it has well penetrated in developing as well as under developed countries. Majority of the drugs prescribed for treating intra abdominal infections include generic antibiotics. Due to this a large number of small players operate in the market. India being the home for generic drugs manufacturers, low cost drugs are made available to lower income group; thus increasing market penetration.
Some of the key players in the intra abdominal infection market include AstraZeneca PLC, Merck & Co., Inc., Atox Bio Inc., Pfizer, Inc. Major generic drug manufacturers include Aurobindo Pharma Ltd., Dr Reddys Labs Ltd, and Teva.
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