Tags: Vancocin

Specific Anti-Infective Agents

Antibiotics Before prescribing a specific antibiotic, clinicians should be able to answer these questions: •  How does the antibiotic kill or inhibit bacterial growth? •  What are the antibiotic’s toxicities and how should they be monitored? •  How is the drug metabolized, and what are the dosing recommendations? Does the dosing schedule need to be modified in patients with renal dysfunction? •  What are the indications for using each specific antibiotic? •  How broad is the antibiotic’s antimicrobial spectrum? •  How much does the antibiotic cost? Clinicians should be familiar with the general classes of antibiotics, their mechanisms of action, and their major toxicities. The differences between the specific antibiotics in …

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Antimicrobial therapy: general principles

A wide variety of antimicrobial agents is available to treat established infections caused by bacteria, fungi, viruses, or parasites. This section will cover the general principles of antimicrobial therapy and will also include illustrative clinical problems to emphasize proper decision-making in using antimicrobials. Determinants of Antimicrobial Efficacy Measurement of antimicrobial activity in vitro Susceptibility testing is indicated for any bacterial pathogen warranting chemotherapy. Drugs that irreversibly destroy the ability of an organism to replicate, and perhaps in the process destroy the structural integrity of the organism, are microbicidal. Drugs that reversibly impair replicating ability, with this function being restored when drug concentrations fall below critical inhibitory levels, are microbiostatic. In quantitative …

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Management of Bacterial Meningitis

Central nervous system infections, especially bacterial meningitis, are frequently life-threatening and usually constitute medical emergencies that require accurate and prompt treatment. (Portions of this section about meningitis have previously been published [Swartz and O'Hanley 1987] and are reproduced with permission of the publisher, Scientific American Medicine, New York. [Send permission to section editor.]) Fortunately, advances in methods of diagnosis and treatment developed during the past 15 years have significantly improved the prognosis associated with many of these illnesses. New diagnostic methods (such as latex agglutination and polymerase chain reaction) supplement rather than supplant cerebrospinal fluid studies. The cerebrospinal fluid studies frequently provide important initial information needed for clinical and microbiologic diagnosis; …

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Vancomycin Hydrochloride

• Vancomycin is a tricyclic glycopeptide antibiotic that is unrelated to other commercially available antibiotics. Drug Interactions • Ototoxic and Nephrotoxic Drugs Because of the possibility of additive toxicities, the concurrent or sequential systemic or topical use of other ototoxic and/or nephrotoxic drugs (e.g., aminoglycosides, amphotericin B, bacitracin, cisplatin, colistin, polymyxin B) and vancomycin requires careful monitoring of renal and auditory functions; these drugs should be used with caution in patients receiving vancomycin therapy. Acute Toxcicity Limited information is available on the acute toxicity of vancomycin. The IV LD50 of the drug in rats or mice is 319 or 400 mg/kg, respectively. Treatment of vancomycin overdosage is mainly supportive with maintenance …

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Community-Acquired Pneumonia: Current Therapies

Overview Many highly effective agents are available for the treatment of bacterial community-acquired pneumonia (community-acquired pneumonia) and other community-acquire respiratory tract infections (RTIs). Currently marketed antibiotics for community-acquired pneumonia demonstrate similar efficacy rates in clinical trials, and these agents have generally achieved clinical symptom resolution in 85-95% of trial participants. The drugs differ mainly in their spectrum of activity (the organisms against which the agent is effective), side-effect profiles, dosing schedules, and dose form availability. Broad-spectrum antibiotics are effective against a wide range of pathogens; narrow-spectrum antibiotics tend to be efficacious against a narrower range of bacterial species, generally either gram-positive or gram-negative organisms.TABLE:Mechanisms of Resistance Against Select Antibacterial Classes, 2004 …

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Glycopeptides – Bactericidal Antibiotics

Overview. Glycopeptides are bactericidal antibiotics used principally for treatment of severe gram-positive infections in patients who cannot receive or who have failed to respond to penicillins and cephalosporins. They may also be used in patients suspected of having pathogens resistant to β-lactams and other anti-infectives. Glycopeptides are believed to be the only antibiotics with universal activity (i.e., no resistance has been reported) against S. pneumoniae, and physicians reserve them for severe community-acquired pneumonia episodes in which multidrug-resistant organisms are suspected or the patient has life-threatening complications such as bacteremia or meningitis. Glycopeptide therapy is relatively well tolerated. The most severe adverse reactions are ototoxicity (dizziness, vertigo, and/or hearing loss) and nephrotoxicity …

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Glycopeptides

Overview. Glycopeptides are used for the treatment of severe or life-threatening infections that are caused by gram-positive organisms such as streptococci and staphylococci. In acute exacerbations of chronic bronchitis , they are used rarely. Physicians typically reserve them for severe acute exacerbations of chronic bronchitis episodes in which multidrug-resistant organisms are suspected or in which the patient has complications, such as bacteremia or meningitis. They are also used as second-line agents in patients who cannot receive or who have failed to respond to penicillins and cephalosporins. Glycopeptide therapy is relatively well tolerated. The most severe adverse reactions are toxicities associated with the inner ear and kidneys, but they occur only infrequently. …

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Acute Exacerbations of Chronic Bronchitis: Current therapies

Overview Numerous highly effective pharmacological agents are available to treat acute exacerbations of chronic bronchitis (acute exacerbations of chronic bronchitis). TABLE:Pharmacological Management of Underlying Disease During an Acute Exacerbation of Chronic Bronchitis summarizes the general pharmacological agents and classes used to manage acute exacerbations of chronic bronchitis. The primary therapies used in acute exacerbations of chronic bronchitis treat the causative infection (antibiotics), relieve symptoms (bronchodilators), and treat the underlying inflammation (corticosteroids). TABLE :Current Therapies Used for Acute Exacerbations of Chronic Bronchitis summarizes the leading antibiotic therapies used to treat the infection. Most acute exacerbations of chronic bronchitis cases require empiric antibiotic therapy because of the difficulty in definitively distinguishing exacerbations of …

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Sepsis

Description of Medical Condition The systemic response to infection; it encompasses a broad array of clinical manifestations and overlaps with inflammatory reactions to other clinical insults (e.g., severe trauma or burn) • Bacteremia: Bacteria in the blood; may have no accompanying symptoms • Systemic inflammatory response syndrome (SIRS) inflammatory reaction to different clinical insults manifest by two of the following: (1) temperature >38°C or90/min; (3) respiratory rate >20/min or PaC02 12,000/mm3, 10% immature forms (bands) • Sepsis: SIRS with documented infection (typically bacterial) • Septic shock: Sepsis induced hypotension (systolic BP 40 mmHg drop from baseline) despite adequate fluid resuscitation plus hypoperfusion abnormalities (oliguria, lactic acidosis, acute change in mental status) …

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Successful Antibiotic Desensitization

Antibiotics are often an essential component of the therapeutic plan that is developed to improve the clinical course of a patient. Typically, certain antibiotics are better for a given clinical condition. Allergies to these antibiotics, however, may limit the use of these antibiotics and in certain cases may complicate the course of optimal care. Allergies to antibiotics have become an great hindrance to the clinician. Today, especially in the context of the diagnosis of HIV, certain drugs, which are considered to be drugs of choice, are very necessary. However, their use may be contraindicated in certain patients because of a pre-existing allergic reactions to these antimicrobials. One approach to using antibiotics

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