![]() Likewise, excretion of unchanged drug in the bile is ideal for biliary or intestinal infections. Excretion of unchanged drug in the urine is ideal for treatment of urinary tract infections, because this will often produce very high drug concentrations in the kidney and bladder.Hepatic metabolism/excretion is generally convenient, because this means the drug dose doesn't need to be adjusted based on renal function.Antibiotics may be metabolized in the liver (often into inactive metabolites) or they may be excreted unchanged in the urine or bile.Specific properties of various antibiotics Requirement for surgical/percutaneous drainage.volume overload, superinfection at different site, drug fever) Development of a new hospital-related problem (e.g.Common causes of treatment failure include:. ![]() ![]() If a patient is failing antibiotic therapy, broadening coverage is usually not the answer.Use of procalcitonin has been shown to limit antibiotic exposure, while possibly improving patient outcomes.Have some sort of plan regarding when to discontinue antibiotics and follow it. Keep track in your notes of how long the patient has been on each antibiotic.Try to choose antibiotics that cover pathogens that the patient has grown in the recent past. Review which antibiotics patient has been exposed to recently try to avoid these if possible.Septic patients may have increased drug clearance, so antibiotics should generally be dosed on the higher end of dose ranges.If possible, get cultures before starting antibiotics.Don't treat colonization except in very specific situations (e.g. Colonization commonly occurs in the bladder of anuric or catheterized patients, or sputum of intubated patients. A positive culture may represent infection or colonization (bacteria present without causing disease).Antibiotics shouldn't be started blindly (without a defined source of infection) unless the patient has septic shock or neutropenic fever.Patients are critically ill, so we're justified in using broad-spectrum agents initially. cefepimeĪntibiotics in the ICU are in some ways simpler than antibiotic therapy for less ill patients. □ Drug-resistant gram positive cocci: vancomycin vs.Some common antibiotic selection debates:.Extended-spectrum beta-lactamases (ESBL).Drug-resistant organisms of particular importance.Macrolides (Azithromycin, Clarithromycin).General considerations for antibiotic therapy.
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