Antimicrobials selection

Select empirical antimicrobial therapy based on spectrum-of-activity considerations that provide a measured response proportional to the severity of illness. Provide a rationale for why a measured response in antimicrobial selection is appropriate. 

Drug-specific considerations in antimicrobial selection include the spectrum of activity, effects on nontargeted microbial flora, appropriate dose, pharmacokinetic and pharmacodynamic properties, adverse-effect and drug-interaction profile, and cost. 

Inadequate diagnosis resulting in poor initial antimicrobial selection, poor source control, or the development of a new infection with a resistant organism is a relatively common cause of antimicrobial failure. 

Host factors can help to ensure selection of the most appropriate antimicrobial agent. Age is an important factor in antimicrobial selection. With regard to dose and interval, renal and hepatic function varies with age. Populations with diminished renal function include neonates and the elderly. Hepatic function in the neonate is not fully developed, and drugs that are metabolized or eliminated by this route may produce adverse effects. For example, sulfonamides and ceftriaxone may compete with bilirubin for binding sites and may result in hyperbilirubinemia and kernicterus. Gastric acidity also depends on... 

If symptoms do not improve, the patient should be evaluated for persistent infection. There are many reasons for poor patient outcome with intraabdominal infection improper antimicrobial selection is only one. The patient maybe immunocompromised, which decreases the likelihood of successful outcome with any regimen. It is impossible for antimicrobials to compensate for a nonfunctioning immune system. There may be surgical reasons for poor patient outcome. Failure to identify all intraabdominal foci of infection or leaks from a GI anastomosis may cause continued intraabdominal infection. Even when intraabdominal infection is controlled, accompanying organ system failure, most often renal or respiratory, may lead to patient demise. 

Based on culture and susceptibility data (if available), are there any changes that need to be made from your initial empiric antimicrobial selection (i.e., resistance to the regimen initially selected) ... 

The "S", "I", "R" designations are assigned by laboratories based on safely achievable plasma concentrations. A culture and susceptibility report should contain the name of the organism and a list of common antimicrobial agents designated as susceptible, intermediate or resistant. This information is intended to guide antimicrobial selection however, these reports must be interpreted carefully. There are a number of important factors that are not taken into account in these data (Verbist 1993). 

One method that has seen only limited use is antimicrobial rotation. Defined as the prospective and purposeful altering of antimicrobial selection in an effort to prevent or delay the emergence and spread of bacterial resistance, this technique has evolved over the last several decades. Although antimicrobial rotation is simply a variation of antimicrobial control, its motive is focused on resistance... 

Pharmaceutical care of the hospitalized patient with infection is the most traditional role for infectious diseases pharmacists. Numerous opportunities for proactive interventions in antimicrobial selection, dosing, route of administration, and monitoring of patients with changing clinical status make this a popular practice setting for many individuals. 

Infectious diseases pharmacists typically practice in a hospital setting that allows them to devote all their time to managing antimicrobial therapy. All aspects of infectious diseases pharmacotherapy, including interventions on antimicrobial selection, antimicrobial dosing, and intravenous-to-oral conversion are the responsibility of the infectious diseases pharmacist. In addition, the pharmacist is usually responsible for analyzing new antimicrobials for formulary inclusion, medication use evaluations, and antimicrobial restriction or therapeutic interchange policies. 

The increase in resistance among these organisms is believed to be a result of continued overuse of antimicrobials in the community, as well as in hospitals, and the increasing prevalence of immuno-suppressed patients receiving long-term suppressive antimicrobials for the prevention of infections. These resistance patterns are regionally variable, and susceptibihty patterns in the community (or hospital) should be monitored closely to promote rational antimicrobial selection. ... 

Antimicrobial agents may be incorporated into a plastics formulation to preserve the polymeric material by destroying or inhibiting the growth of microorganisms on the product surface. Traditionally, the bulk of antimicrobials have been used for flexible PVC, PU foams and adhesives for susceptible formulations in stressful environments. The antimicrobial selection process is influenced by the polymer and its other additives, the production process and any environmental stresses in the finished article s use. 

Although our use of pharmacodynamic principles has not yet been translated into widespread individualized patient application, they have changed the way we think about antimicrobial selection, dosing, and formulary decisions. 

By methodically changing the side chains and possibly the polymeric backbone, it should be feasible to adjust the antimicrobial selectivity and toxicity of the polymers in a method analogous to the production of AMP and P-oligomers [59]. 

Keywords Antimicrobial, Brassica rapa chinensis, Artocarpus altilis, Solanum melongena fruit, Moringa oleifera leaves, E.coli, S.aureus, Bacillus species, K. pneumonia, C. albicans, antimicrobial selectivity, bacteria susceptibility... 

Further antimicrobial selectivity is seen for the CH3CH2OH extract of Brassica rapa chinensis at a concentration of O.Olg/ml against E. coli and Bacillus subtilis. For the former, AZOI of 209.37 mm is noted, whereas for the latter, AZOI of 12.56 mm was registered. Again for the CH3CH2OH extract, A. altilis at a concentration of O.Olg/ml showed antimicrobial selectivity against E.coli, S.aureus and Bacillus subtilis over C. albicans. For the latter, zero AZOI was observed whereas for the first three, AZOI, ranging from 46.7 mm to 95.00 mm were observed. 

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