Antimicrobials maintenance therapy

High-dose penicillin G traditionally has been the drug of choice for the treatment of pneumococcal meningitis. However, due to increases in pneumococcal resistance, the preferred empirical treatment now includes a third-generation cephalosporin in combination with vancomycin.13 All CSF isolates should be tested for penicillin and cephalosporin resistance by methods endorsed by the CLSI. Once in vitro sensitivity results are known, therapy may be tailored (Table 67-3). Patients with a history of type I penicillin allergy or cephalosporin allergy may be treated with vancomycin. Treatment should be continued for 10 to 14 days, after which no further maintenance therapy is required. Antimicrobial prophylaxis is not indicated for close contacts. 

Gloor et al.82 discovered an additional antimicrobial activity of a distillate of Hamamelis (Aqua Hamamelidis) and urea formulated as a topical dermatological preparation that contains both active ingredients. Although mainly used for their antiinflammatory, hydrating, and barrier-stabilizing effects in dermatitis maintenance therapy, the antimicrobial activity of such products is considered a welcome, an added benefit. 

Oral therapy of infections is usually cheaper and avoids the risks associated with maintenance of intravenous access on the other hand, it may expose the gastrointestinal tract to higher local concentrations of antibiotic with consequently greater risks of antibiotic-associated diarrhoea. Some antimicrobial agents are available only for topical use to skin, anterior nares, eye or mouth in general it is better to avoid antibiotics that are also used for systemic therapy because topical use may be especially likely to select for resistant strains. Topical... 

Baquero F, Asensio C (1979) In van der Waaij D, Verhoef J (eds) New criteria for antimicrobial therapy maintenance of digestive tract colonization resistance. Exerpta Medica, Amsterdam, p 90... 

Santander C, Gravalos RG, Cedenillay AG, Cantero J, Pajares JM (1996) Antimicrobial therapy for Helicobacter pylori infection vs long-term maintenance antisecretion treatment in the prevention of recurrent haemorrhage from peptide ulcer prospective nonran-domized trail of 125 patients. Am J Gastroenterol 91 1549-1552... 

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