Infections by Site: Recommended Antibiotic Therapy: General Considerations
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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.