Antimicrobial agents/therapy

Figure 66-4 provides an overview of patient- and antimicrobial agent-specific factors to consider when selecting an antimicrobial regimen. It further delineates monitoring of therapy and actions to take depending on the patients response to therapy. The duration of therapy depends on patient response and type of infection being treated. 

Therefore, despite the 18% and 25% resistance to penicillin and macrolides, the clinical failure rate is less than this. Owing to the empirical treatment of CAP in the outpatient setting, establishing a meaningful clinical failure rate with any therapy is difficult to do. No studies have been performed that established a correlation between clinical failure rates with a particular antimicrobial agent and the percentage of resistant bacterial pathogens. 

The severity of a patient s infection, based on the PEDIS scale, guides the selection of empirical antimicrobial therapy. While most patients with grade 2 diabetic foot infections can be treated as outpatients with oral antimicrobial agents, all grade 4 and many grade 3 infections require hospitalization, stabilization of the patient, and broad-spectrum IV antibiotic therapy.31... 

The treatment of intraabdominal infection most often requires the coordinated use of three major modalities (1) prompt drainage, (2) support of vital functions, and (3) appropriate antimicrobial therapy to treat infection not eradicated by surgery. Antimicrobials are an important adjunct to drainage procedures in the treatment of secondary intraabdominal infections however, the use of antimicrobial agents without surgical intervention usually is inadequate. For most cases of primary peritonitis, drainage procedures may not be required, and antimicrobial agents become the mainstay of therapy. 

On the fifth day of antimicrobial treatment, determine if parenteral antimicrobial agents can be switched to oral agents to complete therapy. 

Since remarkable symptomatic improvement can be achieved in most patients, antibiotic therapy is obviously the cornerstone of the treatment of SIBO [136], Ideally, the choice of an antimicrobial agent should be based on in vitro susceptibility testing of the bacteria in the small bowel of the individual patient. However, because it is impractical to obtain this information in most cases, the choice of the antibiotic is largely empiric and based on results of published series involving small intestinal cultures [137], Whereas most patients with SIBO have aero-... 

Table 5. Parenterally administered antimicrobial agents which can be used alone or combined to provide effective coverage of the mixed aerobic-anaerobic infections arising from human colonic bacteria for patients requiring preventive therapy...

Although the mechanical periodontal treatment alone is adequate to ameliorate or resolve the clinical condition in most cases, adjunctive antimicrobial agents, delivered either systemically or locally, can enhance the effect of therapy. In this connection, two recent meta-analyses [60, 61] have shown that systemic antimicrobials in conjunction with SRP can offer an additional benefit over SPR alone in the treatment of periodontitis both in terms of change in the clinical attachment level and probing pocket depth. When examining the effect of individual antibiotics, it was found that there were statistically significant improvements in clinical attachment level with tetracy-... 

Definitive therapy should be based on results of appropriately collected cultures and sensitivities, as well as clinical response to empiric antimicrobial agents. 

The majority of patients can be managed with oral antimicrobial agents, such as trimethoprim-sulfamethoxazole or the fluoroquinolones (ciprofloxacin, levofloxacin). When IV treatment is necessary, IV to oral sequential therapy with trimethoprim-sulfamethoxazole or a fluoroquinolone, such as ciprofloxacin or ofloxacin, would be appropriate. 

Absorption is the critical factor that determines entry of an antimicrobial agent into the blood stream when an extravascular route of administration, i.e. oral, intramuscular (IM), or subcutaneous (SC) injection is used. Absorption, the extent of which depends mainly on the physicochemical properties of the antimicrobial agent, is associated with intra-mammary or intra-uterine therapy. 

May be effective in the treatment of acute urinary tract infections caused by susceptible strains of gram-positive and gram-negative bacteria, especially Enterobacter sp. and Escherichia coii. It usually is less effective than other antimicrobial agents in the treatment of urinary tract infections caused by bacteria other than mycobacteria. Consider using only when the more conventional therapy has failed and when the organism has demonstrated sensitivity. 

Methenamine is primarily used for the long-term prophylactic or suppressive therapy of recurring UTIs. It is not a primary drug for therapy of acute infections. It should be used to maintain sterile urine after appropriate antimicrobial agents have been employed to eradicate the infection. 

Glucocorticoids are also used in the treatment of a number of HIV-related disorders, including Pneumocystis carinii pneumonia, demyelinating peripheral neuropathies, tuberculous meningitis, and nephropathy. Glucocorticoids are used as adjunctive therapy in Pneumo cystitis carinii pneumonia to decrease the inflammatory response and allow time for antimicrobial agents to exert their effects. In patients who are immunocompromised because of HIV infection, adjunctive steroids may be less beneficial in promoting survival. 

F. Role in therapy According to Micro-medex, the primary place in therapy of Actimmune is as prophylaxis against infection in patients with chronic granulomatous disease, and as an adjunct to conventional therapies (i.e., antimicrobial agents, bone marrow transplantation, leukocyte infusions) in these patients. 

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