RT Book, Section
A1 Haynes, Andrew S.
A1 MacBrayne, Christine E.
A1 Child, Jason
A1 Parker, Sarah K.
A2 Bunik, Maya
A2 Hay, William W.
A2 Levin, Myron J.
A2 Abzug, Mark J.
SR Print(0)
ID 1190370298
T1 Antimicrobial Therapy
T2 Current Diagnosis & Treatment: Pediatrics, 26e
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781264269983
LK accesspediatrics.mhmedical.com/content.aspx?aid=1190370298
RD 2024/04/24
AB The  discovery  and  rapid  development  of  targeted  antimicrobial  agents,  beginning  in  the  1930s,  are  among  the  most  important  scientific  developments  of  20th-century  medicine.  These  drugs  have  forever  changed  the  practice  of  medicine,  and  antimicrobials  remain  one  of  medicine’s  most  effective  and  widely  used  interventions.  However,  choosing  an  appropriate  antimicrobial  can  be  a  complex  and  difficult  task.  Optimal  antimicrobial  use  requires  appreciation  of  the  complicated  interactions  between  host,  organism,  and  drug.  This  decision-making  process,  summarized  in  Table  39–1,  begins  with  an  accurate  working  diagnosis,  based  on  the  patient’s  clinical  history,  physical  examination,  exposure  history,  and  initial  laboratory  tests.  From  this  foundation,  the  clinician  must  consider  the  most  likely  organism(s)  and  that  organism’s  likely  pattern  of  antimicrobial  susceptibility.  This  information  is  considered  in  the  context  of  numerous  patient-specific  factors,  including  age,  immune  status,  relevant  comorbidities,  site  of  infection,  prior  antimicrobial  exposure,  and  microbiology  of  the  patient’s  prior  infections.  Different  exposures,  based  on  environment,  travel,  diet,  animal  contact,  or  ill  close  contacts,  may  suggest  a  greater  likelihood  of  certain  organisms.  The  pace  and  severity  of  the  illness  are  also  important.  A  severe,  rapidly  progressive  illness  should  be  treated  initially  with  broad-spectrum  antimicrobials  until  a  specific  etiologic  diagnosis  is  made.  A  mildly  ill  ambulatory  patient  should  receive  treatment  with  narrow-spectrum  antimicrobials,  per  national  guidelines  when  available.  However,  decisions  of  when  not  to  use  antimicrobials  are  equally  important,  as  unnecessary  or  additional  drugs  and  longer  durations  may  harm  patients.  A  patient  unlikely  to  have  an  infection,  or  with  an  infection  unlikely  to  benefit  from  antimicrobials  (eg,  viral  respiratory  infection),  should  be  spared  the  added  risk  of  an  adverse  reaction.