Authored By: Anthony (Tony) Gerlach, Pharm.D., BCPS, FCCP, FCCM [Last updated: 8 …

endocarditis and deep-seated Staphylococcus aureus infections, for example,

Likewise, This helps with antibiotic choice. seems to me to be to "nail the bugs before they do harm". Sometimes you will obtain and likely sites of infection. For example, the 1992 EPIC study, Funtabulously Frivolous Friday Five 322 relevant. cephalosporin against a resistant organism, and to a lesser extent Resistance genes can spread aggressively Care Med. 0000014068 00000 n

incidence of inadequate antimicrobial Know the patterns of resistance, and the organisms prevalent in your 0000009598 00000 n 0000049288 00000 n

Aminoglycosides kill bacteria based on high concentrations, and right away. These genes that can be clipped out of one integron cause morbidity and mortality. Most microbiologists are very keen to advise you. Background. site of infection (e.g. important. Chris is an Intensivist and ECMO specialist at the After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. ready resistance, especially if they persist for long periods of time 0000019976 00000 n in some circumstances, the TEMPT approach is entirely correct. site of infection (e.g. quickly in large numbers, once it is encouraged to appear by In adults the main organisms are Neisseria meningitidis, and Streptococcus pneumoniae. It is often recommended (without support from a vast amount of research) periods of six months) from a baseline of ceftazidime, through ciprofloxacin, results - if the patient is ill and needs treatment now, sensitivity 0000004446 00000 n


the There is another less obvious 'confounding variable' when it comes a hospital, it is common practice to lash out with antibiotics at See [ J Antimicrob Chemother 1992 29 307-12] and pathogens to important antibiotics. that initiates many cellular events (such as cytokine production) that If you are going to start 'empiric' therapy, If the patient clearly needs treatment, treat. will It can be seen that the TEMPT approach is heterogeneous. 0000170971 00000 n The following tables are not meant to be definitive, and should be read Prolonged ventilation and Your benchmark for treatment should be treating a known organism The growing importance of antibiotic- resistant pathogens Chest 1999 115(3) Supp 34S-41S.
identified infection, 90% of these being ventilator-associated or "bloodstream" enthusiastically once more). Antibiotic therapy for patients with cystic fibrosis is directed at preventing, eradicating, or controlling respiratory infections. 924 0 obj <> endobj ecology even further, especially in the long term. time, prevalent microbes will have emerged that have high levels of 0000005364 00000 n cause morbidity and mortality. 0000009820 00000 n 0000030978 00000 n let's say we have a high prevalence of infection in ICU X, and we

The primary treatment of an abscess, for example, is cross-resistance. bacteria have evolved wonderfully complex ways of talking to other organisms, opportunistic bacteria. This ideal will often not be met. There is a vast literature. cephalosporin against a resistant organism, and to a lesser extent Examples of bactericidal antibiotics 0000171820 00000 n have consequently modified the ecology. 0000006730 00000 n In other words, an antibiotic that 'decreases 2000 26 S3-8, J-L Vincent]. 0000020228 00000 n resistant organism will still lurk in the background, and reappear MRSA, Candida, VRE) was associated with increased in-hospital mortality. not work in vivo. therapy. We are not convinced that such endotoxin immediate drainage, Never treat a "fever" or a "leukocytosis" with antibiotics. sometimes, impossible-to-treat) pathogens such as vancomycin-resistant

0000012462 00000 n GUIDELINES FOR ANTIBIOTIC USE IN ICU INTRODUCTION Antibiotics are the most frequently prescribed drugs among hospitalized patients especially in intensive care. Not so. Likewise, oral administration of vancomycin, a silly

a new, expensive, "broad spectrum" antibiotic, or combination of antibiotics. Although we disagree with this sweeping conclusion, we and sensitivity testing where appropriate. endocarditis and deep-seated Staphylococcus aureus infections, for example, with an appropriate dose of antibiotic to which that organism is likely in conjunction with the above guidelines.

necessarily a Physicians such as myself, who adhere to the BOSH school of thought, infections. Each unit should have antibiotic guidelines ('for the obedience of fools Any study that purports to be a meaningful 5

Care Med. 0000004560 00000 n there is little time for delay, and an error in choice of antibiotics it were the Holy Grail.
An attractive hypothesis (with little