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Ebook The washington manual of medical therapeutics (35th edition): Part 2

(BQ) Part 2 book "The washington manual of medical therapeutics" presents the following contents: Antimicrobials; sexually transmitted infections, human immunodeficiency virus, and acquired immunodeficiency syndrome; solid organ transplant medicine; gastrointestinal diseases; liver diseases; liver diseases;. and other content. | 15 Antimicrobials David J. Ritchie Matthew P. Crotty Nigar Kirmani Empiric antimicrobial therapy should be initiated based on expected pathogens for a given infection. As microbial resistance is increasing among many pathogens a review of institutional as well as local regional national and global susceptibility trends can assist in the development of empiric therapy regimens. Antimicrobial therapy should be modified if possible based on results of culture and sensitivity testing to agent s that have the narrowest spectrum possible. In some cases shorter durations of therapy have been shown to be as effective as traditionally longer courses. Attention should be paid to the possibility of switching from parenteral to oral therapy where possible as many oral agents have excellent bioavailability. Several antibiotics have major drug interactions or require alternate dosing in renal or hepatic insufficiency or both. For antiretroviral antiparasitic and antihepatitis agents see Chapter 16 Sexually Transmitted Infections Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome Chapter 14 Treatment of Infectious Diseases and Chapter 19 Liver Diseases respectively. ANTIBACTERIAL AGENTS Penicillins GENERAL PRINCIPLES Penicillins PCNs irreversibly bind PCN-binding proteins in the bacterial cell wall causing osmotic rupture and death. These agents have a diminished role today because of acquired resistance in many bacterial species through alterations in PCN-binding proteins or expression of hydrolytic enzymes. PCNs remain among the drugs of choice for syphilis and infections caused by PCN-sensitive streptococci methicillin-sensitive Staphylococcus aureus MSSA Listeria monocytogenes Pasteurella multocida and Actinomyces. TREATMENT Aqueous PCN G 2-5 million units IV q4h or 12-30 million units daily by continuous infusion is the IV preparation of PCN G and the drug of choice for most PCN-susceptible streptococcal infections and neurosyphilis. Procaine PCN G is an IM