Antibiotics therapies

Pneumogstis carini pneumonia (PCP), the most common of the opportunistic infections, occurs in more than 80% of AIDS patients (13). Toxoplasmosis, a proto2oan infection of the central nervous system, is activated in AIDS patients when the 004 count drops and severe impairment of ceU-mediated immunity occurs. Typically, patients have a mass lesion(s) in the brain. These mass lesions usually respond well to therapy and can disappear completely. Fungal infections, such as CTyptococcalmeningitis, are extremely common in AIDS patients, and Histop/asma capsulatum appears when ceU-mediated immunity has been destroyed by the HIV vims, leading to widespread infection of the lungs, Hver, spleen, lymph nodes, and bone marrow. AIDS patients are particularly susceptible to bacteremia caused by nontyphoidal strains of Salmonella. Bacteremia may be cleared by using antibiotic therapy. 

Streptokinase dissolves such fibrin clots, thereby permitting effective antibiotic therapy (201). 

Discuss hypersensitivity reactions and pseudomembranous colitis as they relate to antibiotic therapy. 

Diarrhea related to superinfedion secondary to antibiotic therapy, adverse drug reaction... 

A. abdominal surgery requires starting antibiotic therapy 4 days before surgery... 

Otic preparations are instilled in the external auditory canal and may be used to relieve pain, treat infection and inflammation, and aid in the removal of earwax. When the patient has an inner ear infection, systemic antibiotic therapy is indicated. 

Acute pharyngitis presents a diagnostic and therapeutic dilemma. The majority of sore throats are caused by a variety of viruses fewer than 20% are bacterial and hence potentially responsive to antibiotic therapy. However, antibiotics are widely prescribed and this reflects the difficulty in discriminating streptococcal from non-streptococcal infections clinically in the absence of microbiological documentation. Nonetheless, Strep, pyogenes is the most important bacterial pathogen and this responds to oral penicillin. However, up to 10 days treatment is required for its eradication fixm the throat. This requirement causes problems with compliance since symptomatic improvement generally occurs within 2-3 days. 

As carriers of antibiotic resistance (Chapter 3, Part 4) the emergence of antibiotic-resistant strains has had serious repercussions in the application of antibiotic therapy, and has seriously increased the danger of nosicomial infections. 

Acute and chronic sinusitis can also aggravate asthma, and antibiotic therapy of sinusitis may improve asthma symptoms.3 Nasal polyps are associated with aspirin-sensitive asthma, and adult patients with nasal polyps should be counseled against using non-steroidal anti-inflammatory medications.1,3... 

TABLE 12-5. Recommended Antibiotic Therapy in Acute Exacerbations of COPD... 

Uncomplicated exacerbation Not requiring hospitalization Less than 3 exacerbations per year No comorbid illness I I V, greater than 50% predicted No recent antibiotic therapy Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis Oral Macrolide (azithromycin, clarithromycin) Second- or third-generation cephalosporin (cefuroxime, cefpodoxime, cefdinir, cefprozil) Doxycycline Ketolide (telithromycin) P-Lactam/P-Iactamase inhibitor (amoxicillin-clavulanate) Intravenous Not recommended... 

Complicated exacerbation FEV, less than 50% predicted Comorbid cardiac disease Greater than or equal to 3 exacerbations per year Antibiotic therapy in the previous 3 months Above organisms plus drug-resistant pneumococci, P-lactamase-producing H. influenzae and M. catarrhalis, Escherichia coli, Proteus spp., Enterobacter spp., Klebsiella pneumoniae Oral P-Lactam/P-Iactamase inhibitor (amoxicil 1 i n-clavulanate) Fluoroquinolone with enhanced pneumococcal activity (levofloxacin, gemifloxacin, moxifloxacin) Intravenous P-Iactam/P-Iactamase inhibitor (ampicillin-sulbactam) Second- or third-generation cephalosporin (cefuroxime, ceftriaxone) Fluoroquinolone with enhanced pneumococcal activity (levofloxacin, moxifloxacin)... 

Antibiotic therapy is indicated in three distinct situations over the course of CF (1) early eradication and delay of colonization (2) suppression of bacterial growth once colonization occurs and (3) reduction of bacterial load in acute overgrowth. 

HP infection because it has a sensitivity and specificity greater than 95% and a short turnaround time (2 days). Concomitant acid-suppressive or antibiotic therapy may give false-negatives with this test. 

Monitor the patient for complications related to antibiotic therapy (e.g., diarrhea or oral thrush) during and after completion of HP eradication therapy. 

Empiric antibiotic therapy is an appropriate approach to traveler s diarrhea. Eradication of the causal microbe depends on the etiologic agent and its antibiotic sensitivity. Most cases of traveler s diarrhea and other community-acquired infections result from enterotoxigenic (ETEC) or enteropathogenic (EPEC) Escherichia coli. Routine stool cultures do not identify these strains primary empiric antibiotic choices include fluoroquinolones such as ciprofloxacin or levofloxacin. Azithromycin may be a feasible option when fluoroquinolone resistance is encountered. 

Initiation of prophylactic antibiotics is recommended during acute variceal bleeding this is typically done with an oral fluoroquinolone (e.g., ciprofloxacin 500 mg twice daily x 7 days) or an IV third-generation cephalosporin. Prophylactic antibiotic therapy reduces in-hospital infections and mortality in patients hospitalized for variceal bleeding.44... 

If the presence of SBP is suspected, empiric antibiotic therapy with a broad-spectrum anti-infective agent should be initiated until cultures and susceptibilities are available (Fig. 19-5).45,46 In the setting of presumed infection, delaying... 

Treatment Exit-site infections may be treated immediately with empiric coverage, or treatment may be delayed until cultures return. Empiric treatment of catheter-related infections should cover S. aureus. Coverage for P. aeruginosa should also be included if the patient has a history of infections with this organism.49 Cultures and sensitivity testing are particularly important in tailoring antibiotic therapy for catheter-related infections to ensure eradication of the organism and prevent recurrence or related peritonitis. 

Algorithm for intrapartum antibiotic therapy against group B... 

Group B Streptococcus. Observe the neonate for signs and symptoms of sepsis until 48 hours after birth. If present, start a full diagnostic work-up (including complete blood cell count and blood culture) and empirical antibiotic therapy.43... 

Predisposing Factor Most Likely Pathogens Recommended Empirical Antibiotic Therapy... 

Culture and sensitivity (positive in 70% to 85% without prior antibiotic therapy, positive in less than 20% who have had prior therapy)... 

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