TY  - CHAP
M1  - Book, Section
TI  - Intra-Abdominal Infections
A1  - Gross, Alan E.
A1  - Olsen, Keith M.
A1  - DiPiro, Joseph T.
A2  - DiPiro, Joseph T.
A2  - Talbert, Robert L.
A2  - Yee, Gary C.
A2  - Matzke, Gary R.
A2  - Wells, Barbara G.
A2  - Posey, L. Michael
Y1  - 2017
N1  - 
T2  - Pharmacotherapy: A Pathophysiologic Approach, 10e
AB  - Patient  Care  Process  for  Treatment  of  Complicated  Intraabdominal  InfectionCollectPatient  characteristics  (e.g.,  age,  sex,  weight,  vital  signs,  etc.)  Patient  history  (past  medical,  family,  social),  surgical  operations  (site,  date,  procedure),  and  abdominal  imaging  findingsMedication  history  at  hospital  admission  (include  prescription,  nonprescription,  and  other  substances)  and  drug  allergies  and  intolerances.  Previous  antibiotic  use,  both  inpatient  and  outpatient,  dose  and  duration.Microbiologic  results  from  blood,  intraabdominal  fluids,  and  other  sources.  Susceptibility  results  when  available.Laboratory  results  for  major  organ  function  (particularly  kidney  and  liver),  immune  status,  lactate  AssessDetermine  severity  of  illness  based  on  vital  signs,  acute  organ  dysfunction,  source  controlDetermine  likely  pathogens  based  on  type  of  intraabdominal  infection,  patient's  microbiologic  history,  previous  antibiotic  exposure,  and  response  to  current  therapy.  Consider  that  anaerobic  bacteria  may  be  causative  agents  but  may  not  be  isolated  in  cultures.  Determine  if  other  conditions  are  present  and  likely  to  affect  outcomes.Estimate  creatinine  clearance  and  adjust  drug  doses  as  required.  Assess  drug  interactionsPlanDetermine  goals  of  therapy  such  as  correction  of  the  intra-abdominal  disease  process  and  drainage  of  purulent  collections  and  resolution  of  infection  without  major  organ  system  complications.  Determine  appropriate  antimicrobial  treatment  based  on  severity  of  illness,  likely/confirmed  pathogens,  local  resistance/susceptibility  patterns  (see  Tables  114-6,  114-7,  114-8)Establish  antimicrobial  monitoring  goals  for  efficacy  (e.g.,  resolution  of  infection,  clearance  of  blood  cultures)  and  drug  toxicity.Consider  other  medications  that  may  be  needed  (e.g.,  analgesics,  medications  for  nausea  and  vomiting,  thrombosis  prevention).ImplementInitiate  an  empiric  antimicrobial  regimen  and  establish  tentative  stop  date.  Deescalate  antimicrobial  therapy  to  more  narrow-spectrum  agents  based  on  response  and  microbiologic  data.Assess  patient  as  needed  for  response  to  surgical  control,  medications,  and  other  treatments  and  discontinue  adjunct  medications  when  not  needed  or  indicated.Use  measures  to  avoid  adverse  events  to  medications  and  assess  for  their  occurrence.Assess  pain  control  and  progress  of  gastrointestinal  function.Change  to  oral  medications  when  patient  resumes  oral  feeding.Follow-up:  Monitor  and  EvaluateMonitor  signs  and  symptoms  of  infection  within  2  to  3  days  after  antimicrobials  are  initiated  and  surgical  source  control  is  completed.  Antimicrobial  therapy  can  typically  be  discontinued  4-5  days  after  adequate  source  control  of  complicated  intraabdominal  infections.Monitor  for  emergence  of  resistant  bacterial  isolates  or  Candida  spp.  in  blood  or  other  sourcesMonitor  for  occurrence  of  secondary  infections  such  as  respiratory  and  Clostridium  difficileUpon  hospital  discharge  determine  which  medications  the  patient  should  continue  and  provide  patient  education.  Discontinue  unnecessary  medications.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/17
UR  - accesspharmacy.mhmedical.com/content.aspx?aid=1148580880
ER  -