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KEY CONCEPTS

KEY CONCEPTS

  • image Every attempt should be made to obtain specimens for culture and sensitivity testing prior to initiating antibiotics.

  • image Empirical antibiotic therapy should be based on knowledge of likely pathogens for the site of infection, information from patient history (eg, recent hospitalizations, work-related exposure, travel, and pets), and local susceptibility.

  • image Patients with delayed dermatologic reactions (ie, rash) to penicillin generally can receive cephalosporins. Patients with type I hypersensitivity reactions (ie, anaphylaxis) to penicillins should not receive cephalosporins. Alternatives to the β-lactam antimicrobials include aztreonam, quinolones, sulfonamide antibiotics, or vancomycin based on type of coverage indicated.

  • image Renal function should be considered for every patient who is to receive antibiotics. Hepatic function should be considered for drugs eliminated through the hepatobiliary system, such as clindamycin, erythromycin, and metronidazole.

  • image All concomitant drugs and nutritional supplements should be reviewed when an antibiotic is added to a patient’s therapy to ensure drug-drug interactions will be avoided.

  • image Combination antibiotic therapy may be indicated for polymicrobial infections (eg, intra-abdominal and gynecologic infections), to produce synergistic killing, or to prevent the emergence of resistance.

  • image All patients receiving antibiotics should be monitored for resolution of infectious signs and symptoms (eg, decreasing temperature and white blood cell count) and adverse drug events.

  • image Antibiotics with the narrowest effective spectrum of activity are preferred. Antibiotic route of administration should be evaluated daily, and conversion from IV to oral therapy should be attempted as signs of infection improve for patients with functioning GI tracts (general exceptions are endocarditis and CNS infections).

  • image Patients not responding to an appropriate antibiotic treatment in 2 to 3 days should be reevaluated to ensure (a) the correct diagnosis, (b) that therapeutic drug concentrations are being achieved, (c) that the patient is not immunosuppressed, (d) that appropriate source control has been achieved (ie, abscess and foreign body), or (e) that resistance has not developed.

  • image The main goals of antimicrobial stewardship programs (ASPs) are to optimize antimicrobial selection, dosing, duration, and route of administration while minimizing adverse drug events and the emergence of antimicrobial resistance.

BEYOND THE BOOK

BEYOND THE BOOK

KS is a 65-year-old woman with a past medical history significant for uterine cancer and total abdominal hysterectomy, for which they received radiation and chemotherapy. They present to the emergency department with complaints of nausea, vomiting, and flank pain. Their vital signs and laboratory values are as follows:

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Laboratory Values

C-reactive protein: 224 mg/dL (2,240 mg/L)

WBC: 22,600 cells/mm3 (22.6 × 109 /L)

Bands: 10%

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Vitals

Blood pressure: 95/58

Temperature: 39.4°C (103 °F)

Heart rate: 136 beats/min

  1. Which of the following statements regarding microbiologic studies is false?

    1. Obtaining cultures prior to administration of antimicrobial therapy may improve culture yield.

    2. Ideally two sets of blood cultures should be obtained peripherally from two different sites 1 hour apart.

    3. Coagulase-negative staphylococci recovered from blood ...

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