Antibiotics empirical therapy

Empirical therapy should be directed at the most likely pathogen (s) for a specific patient, taking into account age, risk factors for infection (including underlying disease and immune dysfunction, vaccine history, and recent exposures), CSF Gram stain results, CSF antibiotic penetration, and local antimicrobial resistance patterns. 

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... 

Antibiotics are not essential in the treatment of most mild diarrheas, and empirical therapy for acute GI infections may result in unnecessary... 

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. 

Antibiotic therapy can be modified after Gram stain and culture reports are available. If a diagnosis of type II necrotizing fasciitis is established, the broad-spectrum empirical therapy should be... 

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. 

TABLE 1 20—3. Comparative Advantages and Disadvantages of Various Antibiotic Regimens for Empiric Therapy of Febrile Neutropenic Cancer Patients... 

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. 

INDICATIONS FOR THE CLINICAL USE OE COMBINATIONS OF ANTIMICROBIAL AGENTS Use of antibiotics in combination may be justified (1) for empirical therapy of an infection for which the cause is unknown (2) for treatment of polymicrobial infections (3) to enhance antimicrobial activity for a specific infection (i.e., for synergy) or (4) to prevent emergence of resistance. 

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