Fluid management therapeutic fluids

Parenteral therapy should be maintained imfll the patient is afebrile and less symptomatic. The conversion to an oral antibiotic can be considered if the patient has been afebrile for 48 hoirrs or after 3 to 5 days of IV therapy. The choice of antibiotics in CBP should include those agents that are capable of crossing the prostatic epithelium into the prostatic fluid in therapeutic concentrations and that also possess the spectrum of activity to be effective. Currently, the fluoroquinolones (given for 4 to 6 weeks) appear to provide the best therapeutic option in the management of CBP. 

The expected outcomes for the patient may include an optimal response to therapy, management of common adverse reactions, an absence of diarrhea, maintenance of an adequate intake of fluids, maintenance of adequate nutrition, an understanding of the therapeutic regimen (hospitalized patients), and an understanding of and compliance with the prescribed therapeutic regimen (outpatients). 

Adequate fluid resuscitation to maintain circulating blood volume is essential in managing all forms of shock. Different therapeutic options are discussed in the next section. 

Anthracyclines (daunorubicin, doxorubicin, idarubicin, and epirubicin) are anticancer drugs widely used to manage patients with acute leukemia or breast cancer.22-23 To maximize therapeutic efficacy and minimize the acute myelosuppression and cumulative dose-related cardiotoxicity of these agents, several analytical methods were developed to measure anthracyclines and their metabolites in biologic fluids,24 26... 

Hydralazine and dihydralazine are predominantly arterial vasodilators which cause a reduction in peripheral vascular resistance but also reflex tachycardia and fluid retention. They were used in the treatment of hypertension, in combination with a -blocker and a diuretic. Long-term use of these compounds may cause a condition resembling lupus erythematodes with arthrosis, dermatitis and LE-cells in the blood. This risk is enhanced in women and in patients with a slow acetylator pattern. When combined with the venous vasodilator isosorbide (an organic nitrate) hydralazine was shown to be mildly beneficial in patients with congestive heart failure (V-HEFT I Study). Hydralazine and dihydralazine have been replaced by other therapeutics, both in hypertension treatment and in the management of heart failure. 

Hypotension not responsive to intravenous fluids should be managed with vasopressors, such as dopamine, norepinephrine, epinephrine, and/or phenylephrine. If seizures occur, benzodiazepines should be administered. Due to their pharmacokinetic characteristics, moderate volume of distribution, and low protein binding, procainamide and NAPA may be removed via hemodialysis and hemoperfu-sion. Both procainamide and NAPA serum concentrations should be obtained. Normal therapeutic ranges are procainamide, 3-14pgml NAPA, 12-35 pg ml Measurement of electrolytes, renal function tests, and arterial blood gases should be considered. 

Other more specific routes are employed for the administration of the active substance directly to the therapeutic site. For administration into the central nervous system the intrathecal, epidural or infracistemal injection route is used. Intrathecal injection is an injection into the spinal canal, more specifically into the sub-arachnoid space so that it reaches the cerebrospinal fluid and is useful in spinal anaesthesia, chemotherapy, or pain management applications. This route is also used for antibiotic treatment of infections, particularly post-neurosurgical. Medicines given intrathe-cally must not contain any preservative. 

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