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  • Image not available. Every attempt should be made to obtain specimens for culture and sensitivity testing prior to initiating antibiotics.
  • Image not available. Empirical antibiotic therapy should be based on knowledge of likely pathogens for the site of infection, information from patient history (e.g., recent hospitalizations, work-related exposure, travel, and pets), and local susceptibility.
  • Image not available. Patients with delayed dermatologic reactions (i.e., rash) to penicillin generally can receive cephalosporins. Patients with type I hypersensitivity reactions (i.e., anaphylaxis) to penicillins should not receive cephalosporins. Alternatives to the cephalosporins include aztreonam, quinolones, sulfonamide antibiotics, or vancomycin based on type of coverage indicated.
  • Image not available. Estimated creatinine clearance should be calculated for every patient who is to receive antibiotics and the antibiotic dose interval adjusted accordingly. Hepatic function should be considered for drugs eliminated through the hepatobiliary system, such as clindamycin, erythromycin, and metronidazole.
  • Image not available. 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 not available. Combination antibiotic therapy may be indicated for polymicrobial infections (intra-abdominal, gynecologic infections), to produce synergistic killing (such as β-lactam plus aminoglycoside versus Pseudomonas aeruginosa), or to prevent the emergence of resistance.
  • Image not available. All patients receiving antibiotics should be monitored for resolution of infectious signs and symptoms (e.g., decreasing temperature and white blood cell count) and adverse drug events.
  • Image not available. Antibiotics with the narrowest effective spectrum of activity are preferred. Antibiotic route of administration should be evaluated daily, and conversion from intravenous to oral therapy should be attempted as signs of infection improve for patients with functioning gastrointestinal tracts (general exceptions are endocarditis and central nervous system infections).
  • Image not available. 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 the patient does not have isolated infection (i.e., abscess, foreign body), or (e) that resistance has not developed.

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On completion of the chapter, the reader will be able to:

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  • 1. List the factors that a clinician should follow to select an appropriate antimicrobial regimen.
  • 2. Compare and contrast the normal body temperature when measured orally, rectally, or axillary.
  • 3. Describe the changes in the white blood cell count indicative of bacterial, viral, or fungal infections.
  • 4. List the reasons for obtaining microbiology samples (i.e., blood cultures, sputum, urine, etc.) before the institution of antimicrobial therapy.
  • 5. List the important host factors that must be considered when choosing an antimicrobial regimen for a patient.
  • 6. Name two characteristics of penicillin allergy that indicate cephalosporins should be avoided.
  • 7. Identify major drug–drug interactions for commonly prescribed antiinfectives.
  • 8. List the type of bacterial killing and the pharmacodynamicparameter that best correlates with clinical outcomes for β-lactams, aminoglycosides, and fluoroquinolones.
  • 9. Identify common drug toxicities associated with specific antimicrobial agents.
  • 10. List the factors that should be evaluated when assessing the cost of antimicrobial therapy.
  • 11. Discuss the advantages and disadvantages ...

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