TAILIEUCHUNG - Chapter 127. Treatment and Prophylaxis of Bacterial Infections (Part 8)

Principles of Antibacterial Chemotherapy The choice of an antibacterial compound for a particular patient and a specific infection involves more than just a knowledge of the agent's pharmacokinetic profile and in vitro activity. The basic tenets of chemotherapy, to be elaborated below, include the following: When appropriate, material containing the infecting organism(s) should be obtained before the start of treatment so that presumptive identification can be made by microscopic examination of stained specimens and the organism can be grown for definitive identification and susceptibility testing. Awareness of local susceptibility patterns is useful when the patient is treated empirically. . | Chapter 127. Treatment and Prophylaxis of Bacterial Infections Part 8 Principles of Antibacterial Chemotherapy The choice of an antibacterial compound for a particular patient and a specific infection involves more than just a knowledge of the agent s pharmacokinetic profile and in vitro activity. The basic tenets of chemotherapy to be elaborated below include the following When appropriate material containing the infecting organism s should be obtained before the start of treatment so that presumptive identification can be made by microscopic examination of stained specimens and the organism can be grown for definitive identification and susceptibility testing. Awareness of local susceptibility patterns is useful when the patient is treated empirically. Once the organism is identified and its susceptibility to antibacterial agents is determined the regimen with the narrowest effective spectrum should be chosen. The choice of antibacterial agent is guided by the pharmacokinetic and adverse-reaction profile of active compounds the site of infection the immune status of the host and evidence of efficacy from well-performed clinical trials. If all other factors are equal the least expensive antibacterial regimen should be chosen. Susceptibility of Bacteria to Antibacterial Drugs In Vitro Determination of the susceptibility of the patient s infecting organism to a panel of appropriate antibacterial agents is an essential first step in devising a chemotherapeutic regimen. Susceptibility testing is designed to estimate the susceptibility of a bacterial isolate to an antibacterial drug under standardized conditions. These conditions favor rapidly growing aerobic or facultative organisms and assess bacteriostasis only. Specialized testing is required for the assessment of bactericidal antimicrobial activity for the detection of resistance among such fastidious organisms as obligate anaerobes Haemophilus spp. and pneumococci and for the determination of resistance .

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