Empiric Antibiotics for Sepsis
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Abstract:
Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Early recognition and treatment are the cornerstones of management.Review of the English-language literature.For both sepsis and septic shock "antimicrobials [should be] be initiated as soon as possible and within one hour" (Surviving Sepsis Campaign). The risk of progression from severe sepsis to septic shock increases 8% for each hour before antibiotics are started. Selection of antimicrobial agents is based on a combination of patient factors, predicted infecting organism(s), and local microbial resistance patterns. The initial drugs should have activity against typical gram-positive and gram-negative causative micro-organisms. Anaerobic coverage should be provided for intra-abdominal infections or others where anaerobes are significant pathogens. Empiric antifungal or antiviral therapy may be warranted. For patients with healthcare-associated infections, resistant micro-organisms will further complicate the choice of empiric antimicrobials. Recommendations are given for specific infections.Early administration of broad-spectrum antimicrobial drugs is one of the most important, if not the most important, treatment for patients with sepsis or septic shock. Drugs should be initiated as soon as possible, and the choice of should take into account patient factors, common local pathogens, hospital antibiograms and resistance patterns, and the suspected source of infection. Antimicrobial agent therapy should be de-escalated as soon as possible.Keywords:
Empiric therapy
Organ dysfunction
Empiric treatment
In spite of decreasing case fatality attributable to improved clinical management, patients with severe sepsis or septic shock still have a high mortality rate. This study aimed to describe the impact of respiratory and cardiovascular organ dysfunction (OD) on the outcome of patients with severe sepsis or septic shock (SS).
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In February 2020, "surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children" was published in Intensive Care Medicine and Pediatric Critical Care Medicine. This article gives an interpretation on the guidelines to help Chinese pediatricians better understand it.
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Objective. Uncomplicated urinary tract infection (uUTI) is a common reason for antibiotic treatment in primary health care. Due to the increasing prevalence of antibiotic-resistant uropathogens it is crucial to use the most appropriate antibiotics for first-choice empiric treatment of uUTI. Particularly, it is important to avoid antibiotics associated with a high rate of antimicrobial resistance. This study compares national recommendations from six European countries, investigating recommendations for first-choice antibiotic therapy of uUTI. Setting. General practice in six European countries. Method. Searches were undertaken on PubMed, the Cochrane Library databases, Google, and Google Scholar. Recommendations from different geographical regions in Europe were investigated: Northern Europe (Denmark, Sweden), Western Europe (Scotland), Central Europe (Germany), Southern Europe (Spain), and Eastern Europe (Croatia). Results. The six countries recommended seven different antibiotics. Five countries recommended more than one antibiotic as first-choice treatment. Half of the countries recommended antibiotics associated with a high rate (> 10–20%) of resistant E. coli. All countries recommended at least one antibiotic associated with a low (< 5%) resistance rate. Discussion. The differences in first-choice treatment of uUTI could not be explained by differences in local bacterial aetiology or by different patterns of antimicrobial resistance. Despite resistance rates exceeding 10–20%, sulphamethizole, trimethoprim. or fluoroquinolones were recommended in half of the countries. Conclusion. Within the European countries there are considerable differences in recommendations for empiric first-choice antibiotic treatment of uUTI. In order to reduce the increasing antimicrobial resistance in Europe, it is important to agree on the most appropriate antibiotics for empiric treatment of uUTI.
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The common infective conditions encountered at King Khalid Teaching Hospital, Riyadh, Saudi Arabia were described. These data were collected mostly during a period of 8 years between 1981 to 1988. These infections included brucellosis, cholecystitis, conjunctivitis, enteric fever, gastroenteritis, infective endocarditis, meningitis, otitis media, pneumonia, septicaemia, sorethroat, treponemal infections, urethritis, urinary tract infections, and vaginitis. A scheme for empiric chemotherapy has been suggested for these infections based on the sensitivity results obtained mostly from the microbiology laboratory at Teaching Hospital, Riyadh. This scheme of empiric therapy is offered as a guide only. It does not cover all possibilities and is not intended as a rigid dogma. Empiric therapy has also been suggested for some other infective conditions where sufficient data were not available from the Teaching Hospital. Empiric therapy should be started after relevant specimens are collected. Culture and sensitivity tests are invaluable in the management of patients with infectious diseases. As soon as sensitivities of the infecting organisms' are known, treatment should be adjusted accordingly. In some cases, Gram-staining is valuable to guide the initial therapy (eg. meningitis, pneumonia, and urethritis). Finally, close liaison between physicians and clinical microbiologists is mandatory for successful therapy.
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Cause-directed treatment is the mainstay of the current diagnostic approaches for chronic cough. However, empiric therapy has also been advocated in several recent guidelines for the management of chronic cough in adults. This study was designed to evaluate the usefulness of empiric therapy for chronic cough in adults. A literature review is given to discuss the issues related to empiric therapy for chronic cough in adults, including the benefits and limitations of empiric therapy, empiric treatment for the common causes of chronic cough, and the selection of management strategies. Empiric therapy for chronic cough in adults, because of its simplicity and less expense, provides the convenience for doctors in the clinics with limited facilities. It can be used either alone or in combination. When used properly, it can avoid the excessive laboratory investigations and reach the therapeutic success rate similar to cause-directed treatment. Empiric therapy is a simple and useful means for the management of chronic cough in adults and can be used as a surrogate for cause-directed therapy.
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Antimicrobial treatment of otolaryngologic infections can be empiric, supercalculated empiric, or organism-specific. In many instances, it merely is empiric by the epidemiologically established knowledge of the bacterial spectrum for a given infection. Current microbial diagnostic procedures (eg, Gram staining, rapid antigen detection tests, serodiagnostics, nucleic acid amplification procedures, and culture) are analyzed. Direct Gram staining of a swab can be incorporated in the office setting and allows differentiation of the most common pathogens (supercalculated empiric therapy). By this method, treatment can be instituted more specifically with a narrowspectrum antibiotic, and thereby reducing the risk for adverse reactions, costs, and development of resistance. Furthermore, the regional appearance of more resistant gram-positive organisms, as the penicillin-resistant pneumococci or erythromycin-resistant Group A β-hemolytic streptococci and aminopenicillin- resistant Haemophilus influenzae, leads to insecurity with traditional empiric treatment regimens. Current strategies for empiric, supercalculated empiric, and organism-specific therapy are given for various otolaryngologic infections with respect to regional resistance patterns.
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The use of empiric vancomycin plus a third-generation cephalosporin for suspected bacterial meningitis has been recommended since 1997. Although the prevalence of ceftriaxone-nonsusceptible pneumococcal meningitis has decreased, vancomycin should still be included as empiric therapy for bacterial meningitis.
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