Review Article Clinical Update on the Use of Moxifloxacin in the Treatment of Community-Acquired Complicated Intraabdominal Infections William Cheadle, 1,2 James T. Lee, 3 Lena M. Napolitano, 4,5 and Ronald Lee Nichols 6 Abstract Background: Community-acquired complicated intraabdominal infections (cIAIs) present problems for clinicians and have substantial impact on hospital resources. Because of the polymicrobial nature of these infections, successful management of cIAIs depends on timely and appropriate use of antisepsis and antiinfective strategies. Methods: The literature pertinent to this article was reviewed. Results: The Surgical Infection Society and the Infectious Disease Society of America guidelines recommend a variety of single and combined antimicrobial therapies, including fluoroquinolone therapy, for prophylactic and definitive treatment of cIAIs with different severities. Moxifloxacin, a fluoroquinolone, demonstrates a broad spectrum of antimicrobial (including anaerobic) activity, good tissue penetration into the gastrointestinal tract, and a good tolerability profile. Clinical data also have demonstrated that moxifloxacin is effective as mono- therapy for patients with cIAIs. This review identifies the clinical issues impacting antimicrobial selection in cIAI and discusses data on the role of moxifloxacin in light of the current guidelines for management of these patients. Conclusion: Moxifloxacin provides clinicians with a convenient monotherapy option for the treatment of mild- to-moderate cIAIs. C ommunity-acquired complicated intraabdominal in- fections (cIAIs) are encountered frequently in clinical practice and are associated with substantial morbidity and mortality [1]. Mortality rates between 30% and 50% are not uncommon in patients with severe cIAIs [2]. To manage these infections, substantial hospital resources are required [1]. Rapid diagnosis, coupled with the timely use of appropriate antisepsis and antiinfective strategies, may improve outcomes by preventing death or subsequent infections in many pa- tients [1]. In particular, recent clinical data provide compelling evidence for the important role of fluoroquinolone therapy in treating cIAIs. This review addresses the clinical and bacte- riological evidences for the use of moxifloxacin as mono- therapy in the treatment of cIAIs. Intraabdominal Pathophysiology and Infection Classification Intraabdominal infections can be classified as uncompli- cated or complicated. Uncomplicated infections are defined as infectious processes that involve only a single organ, with no anatomical disruption [3]. These infections are often managed with surgical resection alone, without extensive antibiotic therapy, except for preoperative prophylaxis. On the other hand, cIAIs involve infections that extend beyond the hollow viscus of origin into the peritoneal space. These infections are associated with abscess formation or peritonitis and require operative or percutaneous procedures for source control [1,4,5]. Infections with predominantly gram-negative aerobes 1 Department of Surgery, University of Louisville, Louisville, Kentucky. 2 Research and Development, Veterans Affairs Medical Center, Louisville, Kentucky. 3 Department of Surgery (Retired), University of Minnesota Medical School, Minneapolis, Minnesota. 4 Acute Care Surgery [Trauma, Burn, Critical Care, Emergency Surgery] and 5 Department of Surgery, University of Michigan Health Care System, Ann Arbor, Michigan. 6 Department of Surgery-Emeritus, Tulane School of Medicine, New Orleans, Louisiana. SURGICAL INFECTIONS Volume 11, Number 5, 2010 ª Mary Ann Liebert, Inc. DOI: 10.1089=sur.2009.062 487