Antimicrobials empiric-based therapy with

The patient was admitted to the hospital with a presumptive diagnosis of health care-associated pneumonia (based on the recent hospitalization). He received intravenous hydration with normal saline, 5 L oxygen via face mask, an insulin infusion to control his glucose, and empirical antimicrobial therapy with piperacillin-tazobactam 2.25 g intravenously every 6 hours and vancomycin 1 g intravenously every 24 hours. All other medications are continued with the exception of the diabetes medications. 

Empirical therapy should be based on patient- and antimicrobial-specific factors such as the anatomic location of the infection, the likely pathogens associated with the presentation, the potential for adverse effects, and the antimicrobial spectrum of activity. 

Most initial antimicrobial therapy is empirical because cultures usually have not had sufficient time to identify a pathogen. Empirical therapy should be based on patient- and antimicrobial-specific factors such as the anatomic location of the infection, the likely pathogens associated with the presentation, the potential for adverse effects in a given patient, and the antimicrobial spectrum of activity. Prompt initiation of appropriate therapy is paramount in hospitalized patients who are critically ill. Patients who receive initial antimicrobial therapy that provides coverage against the causative pathogen survive at twice the rate of patients who do not receive adequate therapy initially.8... 

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... 

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-... 

Antimicrobial agents are frequently used before the pathogen responsible for a particular illness or the susceptibility to a particular antimicrobial agent is known. This use of antimicrobial agents is called empiric (or presumptive) therapy and is based on experience with a particular clinical entity. The usual justification for empiric therapy is the hope that early intervention will improve the outcome in the best cases, this has been established by placebo-controlled, double-blind prospective clinical trials. For example, treatment of febrile episodes in neutropenic cancer patients with empiric antimicrobial therapy has been demonstrated to have impressive morbidity and mortality benefits even though the specific bacterial agent responsible for fever is determined for only a minority of such episodes. 

Antimicrobial agents are frequently used before the pathogen responsible for a particular illness or the susceptibility to a particular antimicrobial agent is known. This use of antimicrobial agents is called empirical (or presumptive) therapy and is based upon experience with a particular clinical... 

After initiation of empirical antimicrobial therapy, judicious assessment of febrile neutropenic cancer patients is mandatory to evaluate response, clinical status, laboratory data, and potential need for therapy adjustments. After the administration of 72 hours or more of empirical antimicrobial therapy, the clinical status and culture results of febrile neutropenic patients should be reevaluated to determine whether or not therapeutic modifications are necessary. Additions or modifications to the initial antimicrobial regimen likely will be required in patients with ANCs of fewer than 500 cells/mm for greater than a week. Modifications of antimicrobial therapy should be based on clinical and laboratory data antibiotic therapy should be optimized based on culture results. However, during periods of neutropenia, patients generally should continue to receive broad-spectrum therapy because of the risk of secondary infections or breakthrough bacteremias when antimicrobial coverage is too narrow. ... 

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