Combination therapy antimicrobial

Antimicrobial therapy alone is the mainstay of treatment for acute osteomyelitis.7 12 In comparison, treatment for chronic osteomyelitis typically requires a combination of antimicrobial therapy and surgical intervention.3 6 14 15 If the patient is not a candidate for surgical intervention, prolonged antimicrobial therapy is generally necessary.6,10,16... 

Antimicrobial resistance to rifamycins develops rapidly both in vitro and in vivo [65,85,86], As a consequence, all the three members of the family (i.e. rifampicin, rifabutin and rifapentine) are used clinically as components of combination therapies [65,87], Being structurally related, rifaximin could share this potential. And indeed resistance rates, recorded in fecal strains of Enterobacteriaceae, Enterococcus, Bacteroides, Clostridium and anaerobic cocci, ranged between 30 and 90% after short-term (5 days) antibiotic (800 mg daily) treatment [82], A similar pattern was observed in 10 patients with hepatic encephalopathy after treatment with rifaximin 1,200 mg/day for 5 days [80]. 

Because of the high morbidity and mortality associated with PVE and refractoriness to therapy, combinations of antimicrobials are usually recommended. 

Most infections should be treated with a single antimicrobial agent. Although indications for combination therapy exist, antimicrobial combinations are often overused in clinical practice. The unnecessary use of antimicrobial combinations increases toxicity and costs and may occasionally result in reduced efficacy due to antagonism of one drug by another. Antimicrobial combinations should be selected for one or more of the following reasons ... 

To treat polymicrobial infections such as intra-abdominal abscesses. The antimicrobial combination chosen should cover the most common known or suspected pathogens but need not cover all possible pathogens. The availability of antimicrobials with excellent polymicrobial coverage (eg, 13-lactamase inhibitor combinations or imipenem) may reduce the need for combination therapy in the setting of polymicrobial infections. 

Corticosteroids have a range of activity. They have potent antiinflammatory and immunosuppressive activity. Many synthetic drugs are available as corticosteroids. In appropriate doses, these are used as replacement therapy in adrenal insufficiency. The topical application of corticosteroids is safer when compared with systemic use. Corticosteroids should be used in smaller doses for the shortest duration of time. A high dose may be used for life-threatening syndromes or diseases. A tapering pattern of withdrawal should be followed to avoid complications of sudden withdrawal. Systemic therapy is indicated in a variety of conditions. These are administered by intraarticular injections with aseptic conditions for rheumatoid arthritis and osteoarthritis. In skin diseases, such as eczema, contact dermatitis, and psoriasis, corticosteroids are used topically. In some cases, steroids are combined with antimicrobial substances such as neomycin. 

Combination antimicrobial therapy is commonplace in equine practice. However, combination therapy has never been demonstrated to be superior to single drug therapy in controlled clinical trials. The use of multiple antimicrobial agents should be limited to certain situations. 

Because of the uncertainty about spore survival, the lack of effectiveness of antibiotics against the spore form, and recent studies in nonhuman primates demonstrating the effectiveness of postexposure antibiotic prophylaxis in combination with vaccine, physicians may consider two other options for postexposure prophylactic therapy. The first option is a longer period of 100 days of antimicrobial prophylaxis alone. The second alternative option is a combination of antimicrobial prophylaxis plus three doses of anthrax vaccine administered over 4 weeks. 

Additional challenges are associated with the fact that antimicrobial therapy with EPis is a combination therapy by its very nature. In order to provide the maximum pharmacodynamic benefit, the pharmacokinetics ofthe EPI should be appropriately tailored to the pharmacokinetics of the antibiotic component of the combination. 

Combine with antimicrobial therapy when inflammatory lesions are present... 

Antimicrobial combination therapy is used frequently to treat serious infections. Combination therapy may be used prior to knowing the pathogen or antibiotic susceptibility for the treatment of infections in neutropenic patients and in patients with enterococcal endocarditis or bacteremia, sepsis, or pneumonia caused by P. aeruginosa. In these cases, it is important to know whether the combination will have beneficial (or detrimental) effects on the overall antibacterial activity of the regimen. For example, the combination may result in activity that is... 

INDICATIONS FOR THE CLINICAL USE OE COMBINATIONS OF ANTIMICROBIAL AGENTS Use of antibiotics in combination may be justified (1) for empirical therapy of an infection for which the cause is unknown (2) for treatment of polymicrobial infections (3) to enhance antimicrobial activity for a specific infection (i.e., for synergy) or (4) to prevent emergence of resistance. 

D. Antimicrobial Drug Combinations Therapy with multiple antimicrobials may be indicated... 

Petraitis V et al. Combination therapy in treatment of experimental pulmonary aspergillosis in vitro and in vivo correlations of the concentration and dose-dependent interactions between anidulafungin and voriconazole by Bliss independence drug interaction analysts. Antimicrobial Agents and Chemotherapy. 

Today, the ongoing emergence of multidrug-resistant bacteria and many diseases mainly caused by free radicals are serious global problems. Thus, new antimicrobials and novel approaches to combat these problems are urgently needed. Combination therapy is a new approach that may be helpful in treating multidrug-resistant bacteria... 

Omeprazole is clearly the most thoroughly investigated PPI in H. pylori eradication therapy. Its effectiveness in combination with antimicrobials has been proven in a series of well-designed studies. The use of pantopra-zole and lansoprazole in H. pylori eradication therapy have subsequently also been well documented (Tab. 3). 

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