Infections by Site: Recommended Antibiotic Therapy: General Considerations

Infections by Site: Recommended Antibiotic Therapy: General Considerations is a topic covered in the Pocket ICU Management.

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First Things First

An approach to antibiotic selection for ICU patients

  • Patient condition: Do not delay in gravely ill patient.
  • Know the organism: But most often you will have to rely on empiric therapy.
  • Antibiotics with concentration-dependent kinetics such as quinolones and aminoglycosides display increasing killing with increasing concentration above the MIC of the organism: antibiotics with time-dependent kinetics, such as beta-lactams and vancomycin, do not.
  • Site of infection
  • Tissue penetration:Antibiotics that are effective against a microorganism in vitro but unable to reach the site of infection are of little or no benefit to the host.
  • Consider antibiotic resistance
  • ICU environment
    • Know the pattern of resistance and the organisms prevalent in your ICU environment.
  • Refer to antibiotic safety profile.
  • Avoid overtreatment and undertreatment.
  • Avoid delay: If the patient clearly needs treatment, start treatment; do not delay.
  • Take specimens for culture and sensitivity before starting empiric treatment.
  • Discuss your treatment with experts.
  • Review the treatment once you have culture and sensitivity results.
  • Consider factors in antibiotic dosing.

Adjust dose in patients with renal and hepatic insufficiency.

  • Consider cost.
  • Clinical correlation needed for an individual patient. Your ICU environment and other factors at your facility may suggest different treatment. These are only guidelines, not absolute recommendations.
  • Clinical judgment should always guide the physician in selection, dosing, and duration of antimicrobial therapy for individual patients.
  • Use of any drug should be preceded by the careful review of package insert.

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Last updated: April 26, 2010