Presentation on theme: "Antibiotic Therapy. 1 A 90-year-old woman presented to rasool s ED with decreased LOC since two days before the admission, fever and chills. V/s: Bp:100/70."— Presentation transcript:
1 A 90-year-old woman presented to rasool s ED with decreased LOC since two days before the admission, fever and chills. V/s: Bp:100/70 PR:138 O2sat:90%(RA) T:38(axillary) ECG :
2 A 78-year-old previously healthy man presented with two days of cough productive of thick purulent sputum, fever and dyspnea on exertion. Vital signs—Bp;96/60 mm Hg, PR; 116 beats/min, RR;24 breaths/min,Temp;38 rectal. Lung examination revealed scattered ronchi, which were greater on the right than the left.
3 A 28-year-old IVDU man presented with four days of myalgias, fever, dyspnea. V/s : Bp;105/70 mm Hg, PR; 109, RR:18 Temp;38 (oral). Heart examination revealed systolic murmur.
4 A 56-year-old cirrhotic man presented with one week of anorexia, fever, nausea. V/s : Bp;130/80 mm Hg, PR; 92, RR:22 Temp;39.5(oral). Abdominal examination revealed generalized abdominal pain.
SBP The choice of agents is driven by the anticipated bacteriology of the process. A third-generation cephalosporin such as cefotaxime is considered to be the agent of choice, with a demonstrated cure rate of 90%. An alternative is an ampicillin-sulbactam combination. Ampicillin withan aminoglycoside also is effective but is associated with an increased risk of renal toxicity.
Cholecystitis Unless clinical evidence of sepsis exists: coverage with a single broad-spectrum antibiotic (e.g., a second- or third-generation cephalosporin) is adequate.
cholanitis Single-agent therapies include: piperacillin plus tazobactam, mezlocillin, imipenem,meropenem, ticarcillin plus clavulanate, and ampicillin plus sulbactam (which may be combined with metronidazole). Combination therapy includes: a regimen of extended spectrum cephalosporin, metronidazole, and ampicillin.
Acute Pancreatitis A recent study with good methodology compared intravenous ciprofloxacin plus metronidazole with placebo and found no difference with respect to the development of infected pancreatic necrosis. It remains reasonable to begin broad- spectrum antibiotics in those patients with severe acute pancreatitis.
8 A 42-year-old woman presented to the ED with upper abdominal pain and vomiting. She had a uterine myomectomy four months earlier.
SBO Broad-spectrum antibiotics are appropriate when surgery is planned and when the clinical picture suggests vascular compromise or intestinal perforation. Antibiotic use should provide coverage for gram-negative and anaerobic organisms that colonize the intestinal contents (e.g., second- generation cephalosporins).
Acute Appendicitis Once the decision to operate has been made, prophylactic antibiotics should be given. Intravenous second-generation cephalosporins such as cefotetan or cefoxitin provide good coverage.
In cases with a high likelihood of perforation, the traditional treatment has been a broad- spectrum triple antibiotic regimen; however, recent studies suggest that “single coverage” with a second-generation cephalosporin, mirapenam, or combination drug like pipercillin and tazobactam provides similar coverage,with easier administration.
For patients with evidence of obvious perforation and abscess formation, many surgeons prefer to drain the abscess nonoperatively and treat the condition with intravenous antibiotics and then perform an interval appendectomy 6 weeks later. Recently, it has even been suggested that the appendix may not have to be removed after successful abscess resolution.
Antibiotics are indicated if gangrene or perforation is suspected.
Meningitis Prophylaxis Health care workers are not at increased risk for the disease and do not require prophylaxis unless they have had direct mucosal contact with the patient’s secretions, as might occur during mouth-to-mouth resuscitation, endotracheal intubation, or nasotracheal suctioning. Ciprofloxacin 500 mg by mouth (adults only) and ceftriaxone 250 mg intramuscularly (125 mg intramuscularly for children younger than 15 years) provide single-dose alternatives.
Leukopenia In adults, leukopenia is defined as an absolute blood cell count less than 4000 cells/mm3. The absolute neutrophil count can be classified as mild (1000–1500 cells/mm3), moderate (500–1000 cells/mm3), or severe (<500 cells/mm3) according to the risk for infection.