TAILIEUCHUNG - Chapter 127. Treatment and Prophylaxis of Bacterial Infections (Part 9)

Site of Infection The location of the infected site may play a major role in the choice and dose of antimicrobial drug. Patients with suspected meningitis should receive drugs that can cross the blood-CSF barrier; in addition, because of the relative paucity of phagocytes and opsonins at the site of infection, the agents should be bactericidal. Chloramphenicol, an older drug but occasionally useful in the treatment of meningitis, is bactericidal for common organisms causing meningitis (., meningococci, pneumococci, and Haemophilus influenzae, but not enteric gram-negative bacilli), is highly lipid-soluble, and enters the CSF well. However, β-lactam drugs, the mainstay of. | Chapter 127. Treatment and Prophylaxis of Bacterial Infections Part 9 Site of Infection The location of the infected site may play a major role in the choice and dose of antimicrobial drug. Patients with suspected meningitis should receive drugs that can cross the blood-CSF barrier in addition because of the relative paucity of phagocytes and opsonins at the site of infection the agents should be bactericidal. Chloramphenicol an older drug but occasionally useful in the treatment of meningitis is bactericidal for common organisms causing meningitis . meningococci pneumococci and Haemophilus influenzae but not enteric gram-negative bacilli is highly lipid-soluble and enters the CSF well. However 0-lactam drugs the mainstay of therapy for most of these infections do not normally reach high levels in CSF. Their efficacy is based on the increased permeability of the blood-brain and blood-CSF barriers to hydrophilic molecules during inflammation and the extreme susceptibility of most infectious organisms to even small amounts of p-lactam drug. The vegetation which is the major site of infection in bacterial endocarditis is also a focus that is protected from normal host-defense mechanisms. Antibacterial therapy needs to be bactericidal with the selected agent administered parenterally over a long period and at a dose that produces serum levels at least eight times higher than the minimal bactericidal concentration MBC for the infecting organism. Likewise osteomyelitis involves a site that is resistant to opsonophagocytic removal of infecting bacteria furthermore avascular bone sequestrum represents a foreign body that thwarts normal hostdefense mechanisms. Chronic prostatitis is exceedingly difficult to cure because most antibiotics do not penetrate through the capillaries serving the prostate especially when acute inflammation is absent. Intraocular infections especially endophthalmitis are difficult to treat because retinal capillaries lacking fenestration hinder .

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