Antimicrobials prophylactic

Be able to recommend appropriate prophylactic antimicrobial(s) given a surgical operation. 

Choosing the appropriate prophylactic antimicrobial relies on anticipating which organisms are likely to be encountered during the operation. 

Prophylactic antimicrobials should be started within an hour of the first incision to optimize patient outcomes. Exceptions to this include vancomycin and fluoroquinolones. 

The CSFs should not be used routinely for treatment of febrile neutropenia in conjunction with antimicrobial therapy.5 However, the use of CSFs in certain high-risk patients with hypotension, documented fungal infection, pneumonia, or sepsis is reasonable. A recent meta-analysis demonstrated that hospitalization and neutrophil recovery are shortened and that infection-related mortality is marginally improved.14 As with prophylactic use of these agents, cost considerations limit their use to high-risk patients. 

Animal and human studies support the use of antibiotics for the prevention of infectious morbidity and mortality in severe ANP. The most effective antimicrobial agents are the fluoroquinolones, imipenem-cilastatin, and metronidazole, which achieve adequate penetration into pancreatic juice and necrotic tissue and inhibit the growth of enteric bacteria. Although a recent meta-analysis [185] suggested that prophylactic antibiotic administration reduces sepsis and mortality and this approach has been recommended by recent guidelines and consensus state-... 

Traditionally, treatment of CGD entailed prophylactic administration of antimicrobial agents in an attempt to prevent occurrence of severe infection. However, affected individuals still experience life-threatening infections, requiring hospitalization and intensive medical care, as often as once a year. Attempts to control these infections rely on strong antimicrobial agents and leukocyte transfusions. 

Prevent IE in high-risk patients with appropriate prophylactic antimicrobials. 

The choice of the prophylactic antimicrobial depends on the type of surgical procedure, most likely pathogenic organisms, safety and efficacy of the antimicrobial, current literature evidence supporting its use, and cost. 

The role of prophylactic antimicrobials depends on the type of procedure performed and preexisting risk factors for infection. There are insufficient clinical trials to provide general recommendations. 

In patients who have frequent symptomatic infections, long-term prophylactic antimicrobial therapy may be instituted (see Table 50-4). Therapy is generally given for 6 months, with urine cultures followed periodically. 

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. 

Prophylactic antimicrobial therapy to avoid any secondary infection e.g. pneumonia and infection due to tracheostomy or urinary catheterization. 

Schaeffer EM. Prophylactic use of antimicrobials in commonly performed outpatient urologic procedures. Nat Clin Pract Urol. 2006 3 24-31. 

Among biologically active compounds - derivatives of isatin - there is methisazone (1-methylisatin 3-thiosemicarbazone), which has been used as a prophylactic agent against the smallpox virus [139-141], Methods for the synthesis of compounds with the general formula 146 have been developed in the search for new antiviral and antimicrobial agents [142] ... 

In addition, even when prophylactic reduction of the microbial flora is wanted, for example, in handwashing of nurses, with use of antiseptic preparations, no reductions beyond an equilibrium level in counts of hand flora were attained.75 The numbers of organisms spread from the hands of nurses who washed frequently with an antimicrobial soap actually increased after a period of time this increase is associated with declining skin health.76... 

Certain clinical situations (Figure 28.8) require the use of antibiotics for the prevention rather than the treatment of infections. Since the indiscriminate use of antimicrobial agents can result in bacterial resistance and superinfection, prophylactic use is restricted to clinical situations in which benefits outweigh the potential risks. The duration of prophylaxis is dictated by the duration of the risk of infection. 

Yedery, R. D., and Reddy, K. V. (2005), Antimicrobial peptides as microbicidal contraceptives Prophecies for prophylactics—A mini review, Eur. I. Contracept. Reprod. Health Care, 10, 32-42. 

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