TAILIEUCHUNG - Chapter 115. Approach to the Acutely Ill Infected Febrile Patient (Part 2)

The Acutely Ill Patient: Treatment In the acutely ill patient, empirical antibiotic therapy is critical and should be administered without undue delay. Increased prevalence of antibiotic resistance in community-acquired bacteria must be considered when antibiotics are selected. Table 115-1 lists first-line treatments for infections considered in this chapter. In addition to the rapid initiation of antibiotic therapy, several of these infections require urgent surgical attention. Neurosurgical evaluation for subdural empyema or spinal epidural abscess, otolaryngologic surgery for possible mucormycosis, and cardiothoracic surgery for critically ill patients with acute endocarditis are as important as antibiotic therapy. For infections such as necrotizing. | Chapter 115. Approach to the Acutely Ill Infected Febrile Patient Part 2 The Acutely Ill Patient Treatment In the acutely ill patient empirical antibiotic therapy is critical and should be administered without undue delay. Increased prevalence of antibiotic resistance in community-acquired bacteria must be considered when antibiotics are selected. Table 115-1 lists first-line treatments for infections considered in this chapter. In addition to the rapid initiation of antibiotic therapy several of these infections require urgent surgical attention. Neurosurgical evaluation for subdural empyema or spinal epidural abscess otolaryngologic surgery for possible mucormycosis and cardiothoracic surgery for critically ill patients with acute endocarditis are as important as antibiotic therapy. For infections such as necrotizing fasciitis and clostridial myonecrosis rapid surgical intervention supersedes other diagnostic or therapeutic maneuvers. Table 115-1 Empirical Treatment for Common Infectious Disease Emergencies Clinical Syndrome Possible Etiologies Treatment Comme nts S ee Chap. Sepsis without a Clear Focus Septic shock Pseudom onas spp. gram-negative Vancomycin 1 g q12h plus Adjust treatment when culture data 1 29 130 143 or Cefepime 2 g q12h fludrocortisone6 may improve outcome in patients with septic shock. Overwhel ming post- splenectomy sepsis Streptoc occus pneumoniae Haemophilus influenzae Neisseria meningitidis Ceftriaxone 2 g q12h plus Vancomycin 1g q12h If a p-lactamsensitive strain is identified vancomycin can be discontinued. 2 65 Babesiosis Babesia microti . Either Atovaqu one and 2 01 .

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