Antibiotics empiric therapy with

The treatment of SARS involves primarily supportive care and procedures to prevent transmission to others. Owing to the uncertainty associated with the diagnosis of SARS, empirical therapy with broad-spectrum antibiotics should be employed. To date, fluoroquinolones or macrolides typically have been used. Although its efficacy is unproven, patients also have been treated with ribavirin. Owing to the potential benefit of corticosteroids in the presence of progressive pulmonary disease, methylprednisolone also has been used in doses ranging from 80 to 500 mg/day. 

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... 

Empirical therapy for postoperative infections in neurosurgical patients (including patients with CSF shunts) should include vancomycin in combination with either cefepime, ceftazidime, or meropenem. Linezolid has been reported to reach adequate CSF concentrations and resolve cases of meningitis refractory to vancomycin.35 However, data with linezolid are limited. The addition of rifampin should be considered for treatment of shunt infections. When culture and sensitivity data are available, pathogen-directed antibiotic therapy should be administered. Removal of infected devices is desirable aggressive antibiotic therapy (including high-dose intravenous antibiotic therapy plus intraventricular vancomycin and/or tobramycin) may be effective for patients in whom hardware removal is not possible.36... 

Fever of 38.5°C (101.3°F) or higher should be evaluated promptly. A low threshold for empiric antibiotic therapy with coverage against encapsulated organisms is recommended (e.g., ceftriaxone for outpatients and cefotaxime for inpatients). 

As long as there is no positive bacteriological result from the bile (or blood), antibiotics are administered on empirical and plausible principles. In this case, mezlocillin or piperacillin is initially recommended, 3x2 (-4 or -5) g/day, i.v. (55) These antibiotics are effective against virtually all bacteria in acute cholangitis, since they can reach high biliary concentrations. Once the course of disease has entered a more severe stage, an additional dose of tobramycin, for example, is indicated (e.g. 3 x 80 mg/day, i.v.). A septic clinical picture requires a course of triple therapy with ureidopenicillin + aminoglycoside (see above) + metronidazole (3 x 500 mg/ day, i.v.). 

Love LJ, Schimpff SC, Hahn DM, Young VM, Standiford HC, Bender JF, Fortner CL, Wiernik PH. Randomized trial of empiric antibiotic therapy with ticar-cillin in combination with gentamicin, amikacin or netilmicin in febrile patients with granulocytopenia and cancer. Am J Med 1979 66(4) 603-10. 

There has been an open, randomized comparison of amphotericin deoxycholate 0.5 mg/kg/day intravenously versus fluconazole 400 mg/day orally for empirical antifungal therapy in neutropenic patients with cancer and fever refractory to broad-spectrum antibiotics (51). Patients with abnormal hepatic or renal function were excluded, as were those with proven or suspected invasive fungal infection. The mean duration of therapy was 8.3 days with amphotericin deoxycholate and 7.9 days... 

Patients with documented SBP, positive ascitic fluid cultures, or ascitic fluid PMN count >250 cells/mm, regardless of symptoms, should receive broad-spectrum empiric antibiotic therapy with cefotaxime 2 g every 8 hours, or a similar third-generation cephalosporin. Patients with ascitic fluid PMN counts <250 cells/mm , but with signs and symptoms of infection (abdominal pain, tenderness, fever, encephalopathy, renal failure, acidosis, or peripheral leukocytosis), should also receive empiric antibiotic treatment with cefotaxime 2 g every 8 hours, or a similar third-generation cephalosporin. Outpatient oral therapy of SBP with fluoroquinolones or amoxicillin-clavulanic acid awaits further clinical trials. Short-term inpatient quinolone therapy should be considered for the prevention of SBP in patients with low-protein ascites (<1 g/dL), variceal hemorrhage, or prior SBP. 

Some clinicians believe that empirical therapy of osteomyelitis and septic arthritis in a child younger than 5 years of age no longer requires H. influenzaetype b coverage, whereas others are concerned about children not being fully vaccinated and desire to use an antibiotic with activity against this organism. 

Bone infections in patients with a history of intravenous drug abuse require coverage for gram-negative organisms therefore, empirical treatment with ceftazidime 2 g intravenously every 8 hours plus an aminoglycoside is indicated. If compliance can be ensured, these patients are excellent candidates to receive oral ciprofloxacin 750 mg twice daily. Antibiotic therapy in these patients should be continued for at least 4 to 6 weeks. 

At least four different types of empirical parenteral antibiotic regimens are in use (1) monotherapy with an antipseudomonal cephalosporin (cefepime or ceftazidime) or antipseudomonal car-bapenem (imipenem-cilastatin or meropenem), (2) combination therapy with an aminoglycoside plus an antipseudomonal penicillin (piperacillin-tazobactam or ticarciUin-clavulate), an antipseudomonal cephalosporin, or an antipseudomonal carbapenem, (3) vancomycin plus an antipseudomonal cephalosporin or antipseudomonal carbapenem, with or without an aminoglycoside, and (4) a fluoroquinolone (ciprofloxacin or levofloxacin) in combination with an... 

Ciprofloxacin is a fluoroquinolone antibiotic that interferes with microbial DNA synthesis. It is indicated in the treatment of infections of the lower respiratory tract, skin and skin structure, bones and joints, urinary tract gonorrhea, chancroid, and infectious diarrhea caused by susceptible strains of specific organisms typhoid fever uncomplicated cervical and urethral gonorrhea women with acute uncomplicated cystitis acute sinusitis nosocomial pneumonia chronic bacterial prostatitis complicated intra-abdominal infections reduction of incidence or progression of inhalational anthrax following exposure to aerosolized Bacillus anthracis. Cipro IV Used for empirical therapy for febrile neutropenic patients. 

Empiric therapy should be tailored to each institution s resistance profile, but usually will include vancomycin (or cefazolin if low prevalence of MRSA) plus another antibiotic with Gram-negative coverage (e.g., third-generation cephalosporin, carbapenem, or p-lactam/p-lactamase inhibitor). If methicillin-susceptible S. aureus is found as the causative pathogen, then cefazolin or flucloxa-cillin/oxacillin should be the treatment of choice. In general, we prefer antibiotics that need to be administered after dialysis only. The most commonly utilized postdialysis antibiotic regimens include vancomycin, teicoplanin, cefazolin. 

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