Management

Documentation of infection

Review of the patient’s history and symptoms combined with knowledge of the microorganisms that cause infection at specific sites (e.g., E. coli is the most common cause of urinary tract infection in young women, whereas S. pneumoniae is the most common cause of pneumonia at all ages) allows one to order the appropriate investigations to document the site of infection and the infecting microorganism. Nonspecific Methods Symptoms and physical signs are frequently supportive of a diagnosis of infection but rarely are pathognomonic. For example, the activation of the acute inflammatory response is the most common way in which the clinical manifestations of infection become apparent. However, noninfectious conditions may also activate …

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Management of selected clinical conditions

This section is devoted to topics that exemplify important considerations in treatment and prophylaxis with antibiotics. Overviews are provided by discussing selected clinical settings and the therapeutic issues they raise. These include rational therapy requiring interference at specific steps in microbial pathogenesis, problems associated with treatment of immunocompromised patients, understanding of pharmacologic features of antimicrobials in order to effect cure, understanding of the epidemiologic aspects of infectious disease, and rational preventive measures. Current Treatment of Human Immunodeficiency Virus The discovery that the human immunodeficiency virus type 1 (human immunodeficiency virus-1) is responsible for the epidemic of acquired immunodeficiency syndrome (acquired immunodeficiency syndrome) has resulted in an intensive search for compounds that …

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Management of the Febrile Neutropenic Patient

Consideration of treatment of the febrile neutropenic patient includes a brief summary of risk factors, organisms responsible for the disease, workup and management of a patient with respect to antimicrobial therapy, and immunoenhancement. Many clinical disease entities can cause a spectrum of immune suppression, and solid and hematologic tumors vary with respect to the degree of immune suppression they produce. Risk factors for infection Neutropenia is defined as an absolute neutrophil count that is less than 1000 cells/mm3. As the count falls below 1000 cells/mm3, the risk of infection increases. Although the degree and rate of fall of neutropenia are important determinants of infection, the duration of profound neutropenia (absolute neutrophil …

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