Antimicrobials duration

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. 

After selection and initiation of antimicrobial regimen, there are a number of additional patient care and monitoring considerations that should be addressed to improve the likelihood of a successful outcome. Patient education, deescalation of antimicrobial therapy based on culture results, monitoring for clinical response and adverse effects, and appropriate duration of therapy are important. 

Pathogen Recommended and Alternative Antimicrobial Therapy (Adult Doses Pediatric Doses) Adverse Effects/Safety Monitoring Duration (Days)... 

What antimicrobial therapy would you recommend Include drug, dosage, route, interval, and duration of therapy. 

Patients with complicated typhoid fever (i.e., metastatic foci, ileal perforation, etc.) should receive parenteral therapy with ciprofloxacin 400 mg twice daily or ceftriaxone 2000 mg once daily. Antimicrobial therapy can be completed with an oral agent after initial control of the symptoms of typhoid fever. In persons with AIDS and a first episode of Salmonella bacteremia, a longer duration of antibiotic therapy (1-2 weeks of parenteral therapy followed by 4 weeks of oral fluoroquinolone) is recommended to prevent relapse of bacteremia. 

The duration of antimicrobial treatment should be for a total of 5 to 7 days for most intraabdominal infections. 

Antimicrobial therapy is the cornerstone of treatment in UTIs. This therapy should ideally be well tolerated, narrow in antimicrobial spectrum, lend itself to patient compliance (taken as infrequently as possible), have adequate concentrations at the site of the infection, and have good oral bioavailability. Table 76-2 reviews antibiotics frequently used to treat UTIs with comments on their use, and Table 76-3 reviews frequency, duration, and doses of those antibiotics. 

The total duration of antimicrobial therapy is typically 4 to 6 weeks. Therapy is often administered intravenously for 1 or 2 weeks and then switched to the oral route. 

The drug, dose, duration, and route of administration of the patient s antimicrobial regimen... 

Discuss the importance of timing, duration, and redosing in relation to antimicrobial prophylaxis in surgery. 

The distinction between prophylaxis and treatment influences the choice of antimicrobial and duration of therapy. 

The goal of antimicrobial dosing for surgical prophylaxis is to maintain antibiotic concentrations above the minimum inhibitory concentration (MIC) of suspected organisms for the duration of the operation. 

Studies have not shown benefit for additional doses of antibiotic and the duration of antimicrobial prophylaxis should not exceed 24 hours. 

The National Surgical Infection Prevention Project and published evidence suggest that the continuation of antimicrobial prophylaxis beyond wound closure is unnecessary.1 Studies have not shown benefit for additional doses of antibiotic and the duration of antimicrobial prophylaxis should not exceed 24 hours. Longer durations of antibiotic prophylaxis are advocated by some guidelines and will be discussed later. 

Cefazolin or cefuroxime are appropriate for prophylaxis in cardiothoracic and vascular surgeries. In the case of 3-lactam allergy, vancomycin or clindamycin are advised. Debate exists on the duration of antimicrobial prophylaxis. The National Surgical Infection Prevention Project cites data that extending prophylaxis beyond 24 hours does not decrease SSI rates and may increase bacterial resistance.1 American Society of Health-System Pharmacists guidelines from 1999 allow for the continuation of prophylaxis for up to 72 hours.22 Duration of therapy should be based on patient factors and risk of development of an SSI. SSIs are rare after cardiothoracic operations, but the potentially devastating consequences lead some clinicians to support longer periods of prophylaxis. 

The most important pharmacodynamic relationship for antimicrobials that display time-depen dent bactericidal effects is the duration that drug concentrations exceed the MIC. 

Antimicrobial therapy is used to treat otitis media however, a high percentage of children will be cured with symptomatic treatment alone. Antibiotic use reduces the duration of symptoms by about 1 day. 

The average duration of antimicrobial therapy in the normal host with sepsis is 10 to 14 days. 

Serial Disease Likely methods of Transmissibility man Infectivity Incubation Duration of Lethality Persistance Vaccination Antimicrobial Antisera... 

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