empiric antibiotic therapy
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Introduction
Empiric antibiotic therapy for suspected infections when the organism(s) are unknown.
Indications
- intra-abdominal infection
- urinary tract infection (UTI)
- pneumonia
- catheter-related sepsis (peripheral or central line)
- endocarditis
- meningitis
- sepsis of unknown site
Management
- general principles
- obtain blood cultures prior to initiating intravenous antibiotics
- when gram stains, previous history, physical exam or laboratory information suggest a specific organism of known susceptibility, empiric therapy should be directed against that organism
- initial therapy should be altered to target identified organisms
- broad spectrum therapy is continued in febrile, neutropenic patients until neutropenia resolves
- additional therapy other than antibiotics may be indicated
- surgical drainage for abscesses
- decongestants for sinusitis
- intra-abdominal infection
- peritonitis
- spontaneous bacterial peritonitis
- secondary peritonitis
- usual pathogens
- generally multiple organisms involved
- gram negative rods
- anaerobes
- Enterococci commonly found, but rarely pathogenic
- antibiotics
- cefotetan or ceftriaxone & metronidazole
- gentamicin & metronidazole
- add ciprofloxacin or amikacin if hospital-acquired
- usual pathogens
- biliary tract infection
- usual pathogens
- gram negative rods
- Streptococcus sp
- anaerobes with previous surgery
- antibiotics
- cefazolin or ampicillin/gentamicin
- cefotetan or add metronidazole if history of biliary surgery
- ampicillin-sulbactam +/- aminoglycoside[2]
- piperacillin or mezlocillin + metronidazole +/- aminoglycoside[2]
- usual pathogens
- pseudomembranous colitis
- usual pathogen: Clostridium difficile
- antibiotics
- oral metronidazole
- oral vancomycin
- peritonitis
- urinary tract infection (UTI)
- suspect infection with resistant organism when:
- history of previous infection with resistant organisms
- patient has recently received antibiotics
- patients with indwelling catheters
- patients with multiple previous UTIs
- patients with spinal cord injury
- community acquired UTI
- nosocomial UTI or otherwise suspected resistant organism
- suspect infection with resistant organism when:
- pneumonia
- communitiy acquired
- nosocomial pneumonia & nursing home patients
- usual pathogens
- antibiotics
- ceftazidime plus nafcillin plus metronidazole
- amikacin plus clindamycin
- lung abscess
- usual pathogens: anaerobes (mixed)
- antibiotics: clindamycin
- AIDS patient
- usual pathogens: Pneumocystis carinii
- antibiotics:
- Bactrim
- erythromycin (occasionally)
- catheter-related sepsis (peripheral or central line)
- usual pathogens
- antibiotics
- vancomycin
- add ceftazidime or amikacin if patient is septic
- endocarditis
- subacute
- usual pathogens
- antibiotics: ampicillin plus gentamicin
- acute
- prosthetic valve
- subacute
- meningitis
- community acquired
- post neurosurgery
- neutropenic host
- usual pathogens
- antibiotics: ceftazidime plus ampicillin
- sepsis of unknown site
- neutropenic host (< 1000 neutrophils/mm3)
- others
More general terms
Additional terms
- antibiotic (antimicrobial agent)
- antibiotic prescribing practices; antibiotic overuse; outpatient parenteral antibiotics
References
- ↑ R Libke, UCSF Fresno, 1998
- ↑ 2.0 2.1 2.2 2.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 16. American College of Physicians, Philadelphia 1998, 2012
- ↑ Charani E et al. Understanding the determinants of antimicrobial prescribing within hospitals: The role of "prescribing etiquette.". Clin Infect Dis 2013 Jul 15; 57:188 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23572483 <Internet> http://cid.oxfordjournals.org/content/57/2/188?ijkey=7cf65eb4af31992aeb93e584e3af5075526f10a7&keytype2=tf_ipsecsha