TAILIEUCHUNG - Chapter 127. Treatment and Prophylaxis of Bacterial Infections (Part 14)

Duration of Therapy and Treatment Failure Until recently, there was little incentive to establish the most appropriate duration of treatment; patients were instructed to take a 7- or 10-day course of treatment for most common infections. A number of recent investigations have evaluated shorter durations of therapy, especially in patients with communityacquired pneumonia. Table 127-10 lists common bacterial infections for which treatment duration guidelines have been established or for which there is sufficient clinical experience to establish treatment durations. The ultimate test of cure for a bacterial infection is the absence of relapse when therapy is discontinued. Relapse is defined. | Chapter 127. Treatment and Prophylaxis of Bacterial Infections Part 14 Duration of Therapy and Treatment Failure Until recently there was little incentive to establish the most appropriate duration of treatment patients were instructed to take a 7- or 10-day course of treatment for most common infections. A number of recent investigations have evaluated shorter durations of therapy especially in patients with community-acquired pneumonia. Table 127-10 lists common bacterial infections for which treatment duration guidelines have been established or for which there is sufficient clinical experience to establish treatment durations. The ultimate test of cure for a bacterial infection is the absence of relapse when therapy is discontinued. Relapse is defined as a recurrence of infection with the identical organism that caused the first infection. In general therefore the duration of therapy should be long enough to prevent relapse yet not excessive. Extension of therapy beyond the limit of effectiveness may increase the medication s side effects and encourage the selection of resistant bacteria. The art of treating bacterial infections lies in the ability to determine the appropriate duration of therapy for infections that are not covered by established guidelines. Re-treatment of infections for which therapy has failed usually requires a prolonged course 4 weeks with combinations of antibacterial agents. Table 127-10 Duration of Therapy for Bacterial Infections Duration of Therapy Infections Single dose Gonococcal urethritis streptococcal pharyngitis penicillin G benzathine primary and secondary syphilis penicillin G benzathine 3 days Cystitis in young women community- or travel-acquired diarrhea 3-10 days Community-acquired pneumonia 3-5 days community-acquired meningitis pneumococcal or meningococcal antibiotic-associated diarrhea 10 days Giardia enteritis cellulitis epididymitis 2 weeks Helicobacter pylori-associated peptic ulcer neurosyphilis penicillin IV .

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