Infection administration route

Infection Administration route route Treatment Survivors Mean survival time of mice that died (days S.E.)... 

The IM and SC routes are by far the most frequently used extravascular parenteral routes of drug administration in farm animals. The less frequently used parenteral routes have limited application, in that they aim at directly placing high concentrations of antimicrobial agent close to the site of infection. These routes of administration include intra-articular or subconjuctival injection and intra-mammary or intra-uterine infusion. These local routes differ from the major parenteral routes in that absorption into the systemic circulation is not a prerequisite for delivery of drug to the site of action. The combined use of systemic and local delivery of drug to the site of infection represents the optimum approach to... 

Superinfections, particularly with fungal infections, may result from bacterial imbalance no matter which administration route is used. 

Successful treatment depends not only on the formulation characteristics but also on the route of administration. For example, the schistosomicidal drug tartar emetic incorporated in PEGylated liposomes was delivered either intraperitoneally or subcutaneously (27mgSb/kg) to mice infected with Schisostoma mansoni [189]. Indeed, 82 and 67% reduction levels of worm were obtained, respectively. However, the efficacy of the formulation given by either administrative route was not significantly different. The only difference was the slower liposome absorption by the subcutaneous route. 

Poorly prepared or administered parenterals can cause patient harm such as thrombus formation, severe hypersensitivity reactions and infection. Because of the disadvantages of the parenteral route other administration routes are preferred. The parenteral route is only considered when other routes cannot be used or when the active substance can only be administered parenterally. This is often the case for patients in the hospital and especially for intensive care patients and other critically ill patients. 

As previously mentioned, systemic delivery is limited because of the isolation of ocular tissues from the systemic circulation thus, topical delivery is often the preferred administration route owing to ease of access and patient compliance, particularly when treating infections of the anterior segment such as keratitis sicca, conjunctivitis, or blepharitis and diseases such as glaucoma or uveitis that require the drug to be diffused across the corneal barrier [19,20]. However, drainage, lacrimation and tear dilution, tear turnover, conjunctival absorption, and the corneal epithelium all limit corneal drug penetration [21,22]. 

Drug administration route Published experience with testosterone pellets of an older type has noted relatively high rates of pellet extrusion (8.5-12%) and infection (1.4-6.8%). A study in 80 men with long-acting testosterone implants (Testopel ), which are smaller and have a smooth surface, has shown that with this formulation extrusion occurred in only 0.3% of cases and infection also in only 0.3% [105 ]. 

In a multicentre observational study to examine the association between administration route or place of insertion of central venous catheters and the incidence of CRI in patients on TPN, there was no significant association between the site of venous access and the incidence of infections. There was a significant relationship between the insertion procedure and incidence of CRI (P=0.0007), with very low incidence rates observed in patients in intensive care units compared with other hospital departments [125 ]. 

Drug administration route There is a greater risk of developing ketoacidosis with insulin-pump therapy than with multiple daily insulin injections, because there is always a smaller subcutaneous depot of insulin at any time with the insulin pump. However, in practice, the frequency of ketoacidosis is similar with insulin pump and insulin injections. Insulin-pump therapy can lead to some localised non-serious skin infections at the infusion site. In general, current pumps are robust and reliable, but malfunctions can still occur. [15 ]... 

MANAGING ANXIETY. Fhtients may exhibit varying degrees of anxiety related to tiieir illness and infection and die necessary drug therapy. When these drug are given by die parenteral route, patients may experience anxiety because of the discomfort or pain that accompanies an IM injection or IV administration. The nurse reassures die patient that every effort will be made to reduce pain and discomfort altiiough complete pain relief may not always be possible. 

The preferred route of administration is intraperitoneal (IP) rather than IV to achieve maximum concentrations at the site of infection. Antibiotics can be administered IP intermittently as a single large dose in one exchange per day or continuously as multiple smaller doses with each exchange. Intermittent administration requires at least 6 hours of dwell time in the peritoneal cavity to allow for adequate systemic absorption and provides adequate levels to cover the 24-hour period. However, continuous administration is better suited for PD modalities that require more frequent exchanges (less than 6-hour dwell time). The reader should refer to the ISPD guidelines for dosing recommendations for IP antibiotics in CAPD and automated PD patients.49 The dose of the antibiotics should be increased by 25% for patients with residual renal function who are able to produce more than 100 mL urine output per day. 

Biologic response modifiers (BRMs) are indicated in patients who have failed an adequate trial of DMARD therapy.1 BRMs may be added to DMARD monotherapy (i.e., methotrexate) or replace ineffective DMARD therapy.22 The decision to select a particular agent generally is based on the prescriber s comfort level with monitoring the safety and efficacy of the medications, the frequency and route of administration, the patient s comfort level or manual dexterity to self-administer subcutaneous injections, the cost, and the availability of insurance coverage.23 In general, BRMs should be avoided in patients with serious infections, demyelinating disorders (e.g., multiple sclerosis or optic neuritis) or heart failure.21... 

Recognizing the presumed site of infection and most common pathogens associated with the infectious source should guide antimicrobial choice, dose, and route of administration. For example, community-acquired pneumonia is caused most commonly by S. pneumoniae, E. coli is the primary cause of uncomplicated UTIs, and staphylococci and streptococci are implicated most frequently in skin and skin-structure infections (e.g., cellulitis). 

Amphotericin B is the mainstay of treatment of patients with severe endemic fungal infections. The conventional deoxycholate formulation of the drug can be associated with substantial infusion-related adverse effects (e.g., chills, fever, nausea, rigors, and in rare cases hypotension, flushing, respiratory difficulty, and arrhythmias). Pre-medication with low doses of hydrocortisone, acetaminophen, nonsteroidal anti-inflammatory agents, and meperidine is common to reduce acute infusion-related reactions. Venous irritation associated with the drug can also lead to thrombophlebitis, hence central venous catheters are the preferred route of administration in patients receiving more than a week of therapy. 

Maintaining adequate nutritional status, especially during periods of illness and metabolic stress, is an important part of patient care. Malnutrition in hospitalized patients is associated with significant complications, including increased infection risk, poor wound healing, prolonged hospital stay, and increased mortality, especially in surgical and critically ill patients.1 Specialized nutrition support refers to the administration of nutrients via the oral, enteral, or parenteral route for therapeutic purposes.1 Parenteral nutrition (PN), also... 

The use of the aerosol route for delivery of antibiotics for pulmonary infections remains controversial. The majority of pediatric studies have been conducted in children with cystic fibrosis. In these patients distribution of the antibiotic to the desired tissue site is impeded because of the viscosity of the sputum in patients with acute exacerbations of their pulmonary infections [91,92], Long-term studies have demonstrated preventive benefits of aerosolized antibiotics in children with cystic fibrosis who are colonizing Pseudomonas aeruginosa in their lungs but are not acutely ill [93,94], Cyclic administration of tobramycin administered by nebulizer has received FDA approval [95],... 

The route of antibiotic administration might be crucial. Animal studies [193, 194] have shown that enteral administration (either by oral or rectal route) of antimicrobials reduces the rate of bacterial translocation and early mortality in rats or mice with experimentally induced pancreatitis. Indeed, in patients with ANP, selective bowel decontamination with oral and rectal antibiotics decreased the infection rate [195]. 

Animal and human studies have demonstrated that rifaximin has very poor intestinal absorption after oral administration, so that blood and urine concentrations of rifaximin are practically undetectable [6], Rifaximin excretion is essentially exclusively by the fecal route [5]. Therefore, when rifaximin is administered by the oral route, it acts locally at the intestinal level and eliminates the bacterial organisms that are causing the infection. The important antibacterial activity of rifaximin appears to be directly related to the high intestinal concentration of the drug and inhibition of bacterial growth. The drug has... 

As the patient improves the route of antibiotic administration should be reevaluated. Switch to oral therapy is an accepted practice for many infections. Criteria favoring switch to oral therapy include ... 

For routes of administration in which the chemical is given orally or placed into an orifice other than the mouth, clear instructions about the correct administration of the chemical must be provided. Many cases are known of oral pediatric drops for ear infections being placed into the ear, and vice versa (ear drops being swallowed) in humans. Errors in test-article administration are especially prevalent when a chemical form is being used in a nontraditional manner (e.g., suppositories that are given by the buccal route). 

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