Systemic antibiotic therapy

Otic preparations are instilled in the external auditory canal and may be used to relieve pain, treat infection and inflammation, and aid in the removal of earwax. When the patient has an inner ear infection, systemic antibiotic therapy is indicated. 

When bacteriuria occurs in the asymptomatic, short-term catheterized patient (less than 30 days), the use of systemic antibiotic therapy should be withheld and the catheter removed as soon as possible. If the patient becomes symptomatic, the catheter should again be removed, and treatment as described for complicated infections should be started. 

In topical preparations, the base of erythromycin rather than a salt is used to facilitate penetration. Although the mechanism of action of topical erythromycin in inflammatory acne vulgaris is unknown, it is presumed to be due to its inhibitory effects on P acnes. One of the possible complications of topical therapy is the development of antibiotic-resistant strains of organisms, including staphylococci. If this occurs in association with a clinical infection, topical erythromycin should be discontinued and appropriate systemic antibiotic therapy started. Adverse local reactions... 

If a significant inflammatory component or a response to bacterial exotoxin hypersensitivity in the fiarm of marginal corneal infiltrates or phlyctenules is present, treatment may require concurrent topical steroid therapy. When chronic dacryocystitis is involved, treatment should include irrigation of the lacrimal system with trimethoprim-polymyxin B or gentamicin. Adjunctive systemic antibiotic therapy may also be required (see Chapter 24). 

Blaise, M., Pateron, D., Trinchet, X-C., Levacher, S., Beaugrand, M., Pourriat, X-L. Systemic antibiotic therapy prevents bacterial infection in cirrhotic patients with gastrointestinal hemorrhage. Hepatology 1994 20 34-38... 

Topoll HH, Lange DE, Muller RF. Multiple periodontal abscesses after systemic antibiotic therapy. J Clin Periodontol 1990 17(4) 268-72. 

A Stage 1 pressure ulcer does not require systemic antibiotic therapy because the skin remains intact. 

Systemic antibiotic therapy is the treatment of choice for cellulitis, an inflammation of the skin and subcutaneous tissue. 

When adhesion of bacteria occurs on the surface of the prosthesis an invasive inflammatory process can be developed. If bacteria proliferation continues, a biofilm is formed, and consequently a three-dimensional structure protects bacteria against the patient s own defense system and from systemic antibiotic therapy [13]. Bacteria do not grow exponentially, but rather exist in a slow growing or starvation state. These microorganisms can produce an extracellular matrix that protects them from a hostile environment, enabling them to evade the host immune system and antibiotic treatment. This biofilm facilitates bacterial survival under nutrient-poor, stressful conditions, which occur in the host, and results in structurally-complex, heterogeneous bacterial aggregates associated with a surface [14,15]. 

Pneumogstis carini pneumonia (PCP), the most common of the opportunistic infections, occurs in more than 80% of AIDS patients (13). Toxoplasmosis, a proto2oan infection of the central nervous system, is activated in AIDS patients when the 004 count drops and severe impairment of ceU-mediated immunity occurs. Typically, patients have a mass lesion(s) in the brain. These mass lesions usually respond well to therapy and can disappear completely. Fungal infections, such as CTyptococcalmeningitis, are extremely common in AIDS patients, and Histop/asma capsulatum appears when ceU-mediated immunity has been destroyed by the HIV vims, leading to widespread infection of the lungs, Hver, spleen, lymph nodes, and bone marrow. AIDS patients are particularly susceptible to bacteremia caused by nontyphoidal strains of Salmonella. Bacteremia may be cleared by using antibiotic therapy. 

Systemic antibiotics are indicated for pressure sores associated with spreading cellulitis, osteomyelitis, or bacteremia. Because the infections usually are polymicrobial, antibiotic therapy should target gram-positive, gram-negative, and anaerobic bacteria. The duration of treatment is generally 10 to 14 days, unless osteomyelitis is present.38... 

An increasing number of both clinical and laboratory-derived observations support the importance of luminal components in driving the inflammatory response in ulcerative colitis and Crohn s disease. Although its role is unclear, antibiotic therapy is commonly used in clinical practice for the treatment of moderately to severely active ulcerative colitis. Metronidazole and/or ciprofloxacin are currently employed in active Crohn s disease, particularly in patients with colonic involvement and with perianal disease. Rifaximin, a rifamycin-derived antibiotic, is characterized by a wide range of antibacterial activity and a very low systemic absorption. Some preliminary data show its efficacy in severe active ulcerative colitis, pouchitis and prevention of postoperative recurrence in Crohn s disease. 

Erythromycin has efficacy similar to tetracycline, but it induces higher rates of bacterial resistance. Resistance may be reduced by combination therapy with benzoyl peroxide. Erythromycin can be used for patients who require systemic antibiotics but cannot tolerate tetracyclines, or those who acquire bacterial resistance to tetracyclines. The usual dose is 1 g/day with meals to minimize GI intolerance. 

Several systemic antibiotics that have traditionally been used in the treatment of acnevulgaris have been shown to be effective when applied topically. Currently, four antibiotics are so utilized clindamycin phosphate, erythromycin base, metronidazole, and sulfacetamide. The effectiveness of topical therapy is less than that achieved by systemic administration of the same antibiotic. Therefore, topical therapy is generally suitable only in mild to moderate cases of inflammatory acne. 

Topical antibiotics are typically available as ointments and are excellent for use on open wounds. Coupled with the antibacterial action of the antibiotic ingredient, topical antibiotic ointments provide a safe and effective option in wound healing. In addition, topical antibiotics are effective for the localized treatment of primary and secondary pyodermas with minimal systemic side effects.14 Prophylactic uses include application for traumatic and surgical wounds, burns, intravascular catheters, and eradication of S. aureus nasal carriage.16 42 The advantage of antibiotic therapy in the treatment of eczematous skin will be discussed in the following article considering AD as an example. 

In AD increased S. aureus colonization plays a fundamental role therefore, antistaphylococcal therapy is part of a successful management of the disease. Epidermal lipid deficiencies and barrier dysfunction contribute to enhanced S. aureus attachment to the skin and mediate immunological and inflammatory effects including the release of superantigens, additional exotoxins, and exoenzymes, and perhaps bacterial DNA-triggered mechanisms. Therapeutic possibilities include the use of topical antiseptics in cases of microbial-laden atopic eczema, corticosteroids, and specific antibiotic-antiseptic combinations in cases of localized superinfected atopic eczema and systemic antibiotics in cases of generalized superinfected atopic eczema.48... 

An explanation for conflicting results in most studies concerning oral antibiotic therapy could be the fact that the anterior nares as a reservoir of S. aureus and the possibility of autotransmission or transmission between patients and their partners often were not considered. Good therapeutic effects were observed when treating the nasal cavity of patient and partners topically in addition to systemic therapy.48,91... 

Whereas LPS itself is chemically inert, the presence of LPS in blood (endotox-emia), often a consequence of antibiotic therapy of preexisting bacterial infections, sets off a cascade of exaggerated host responses, which, under normal, homeostatic conditions, serve to orchestrate innate immune defenses. It is the uncontrolled, overwhelming, and precipitous systemic inflammatory response that ultimately manifests clinically in the frequently fatal shock syndrome characterized by... 

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