Reply to Beheshti et al

Clinical Infectious Diseases, Dec 2012

Joseph S. Solomkin, Harumi Gomi

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Reply to Beheshti et al

0 Center for Clinical Infectious Diseases, Jichi Medical University , Yakushiji, Shimotsuke, Tochigi , Japan 1 (Emeritus), University of Cincinnati College of Medicine , 231 Albert B. Sabin Way, Cincinnati, Ohio 45267-0558 2 University of Cincinnati College of Medicine , Ohio CORRESPONDENCE - Reply to Beheshti et al TO THE EDITORWe very much appreciate the writers careful review and comments regarding both the original SIS/IDSA (Surgical Infection Society/ Infectious Diseases Society of America) guidelines for complicated intra-abdominal infections and the Tokyo guidelines for biliary infections [14]. The concerns regarding the wording that describes the addition of metronidazole to gramnegative agents were addressed in an erratum (Clin Infect Dis 2010. 50(12):1695.) The Tokyo biliary guidelines were generated by a Japanese panel that authored the manuscripts, with a larger audience of Japanese hepatobiliary surgeons voting. The extent of consensus among this group was used to make recommendations, with comments from the more formal Japanese and international panelists added to the manuscripts. Therefore, these guidelines reflected Japanese practice in 2006. A new set of guidelines have been developed using an evidence-based approach and will be available within six months. The recommendations for anaerobic therapy (moderate to severe cholangitis) that exist in the published guidelines will be maintained. The new guidelines add the specific condition of bilio-enteric anastomosis as an indication for anaerobic treatment at all severity levels. The strength of these recommendations are confounded by the absence of sufficient randomized clinical anaerobic therapy trials. There are randomized trials in the cited references that compare regimens with considerable anaerobic activity vs regimens with little such activity. These studies were relatively small, were intended to address the use of specific gram-negative agents, and did not use research level methodologies to detect anaerobes. They showed no differences in outcomes. Recommendations in this area are based on high quality bacteriologic studies where anaerobes, particularly Bacteroides fragilis, exist within the framework of specific clinical circumstances and are generally accepted as pathogens. We believe that patient safety requires the use of anaerobic therapy in an identified subset of patients. Potential conflicts of interest. Both authors: No potential conflicts of interest. Both authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Joseph S. Solomkin1 and Harumi Gomi2 (...truncated)


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Joseph S. Solomkin, Harumi Gomi. Reply to Beheshti et al, Clinical Infectious Diseases, 2012, pp. 1584-1585, 55/11, DOI: 10.1093/cid/cis719