tailieunhanh - CLINICAL PHARMACOLOGY 2003 (PART 15)

We live in a world heavily populated by microorganisms of astonishing diversity. Most of these exist in our external environment but certain classes are normally harboured within our bodies, especially colonising mucosal surfaces. Depending on the circumstances, infectious disease can arise from organisms living exogenously or endogenously, and a knowledge of common pathogens at specific sites often provides a good basis for rational initial therapy. This chapter considers the bacteria that cause disease in individual body systems, the drugs that are used to combat them, and how they are best used. It discusses infection of: Blood Paransal sinuses. | SECTION 3 Chemotherapy of bacterial infections SYNOPSIS We live in a world heavily populated by microorganisms of astonishing diversity. Most of these exist in our external environment but certain classes are normally harboured within our bodies especially colonising mucosal surfaces. Depending on the circumstances infectious disease can arise from organisms living exogenously or endogenously and a knowledge of common pathogens at specific sites often provides a good basis for rational initial therapy. This chapter considers the bacteria that cause disease in individual body systems the drugs that are used to combat them and how they are best used. It discusses infection of Blood Paransal sinuses and ears Throat Bronchi lungs and pleura Endocardium Meninges Intestines Urinary tract Genital tract Bones and joints Eye Also mycobacteria that infect many sites Table p. 21 I is a general reference for this chapter. Infection of the blood Septicaemia is a medical emergency. Accurate microbiological diagnosis is of the first importance and blood cultures should be taken before starting antimicrobial therapy. Usually the infecting organism is not known at the time of presentation and treatment must be instituted on the basis of a best guess . The clinical circumstances may provide some clues. Patients who have been in hospital for some time before presenting with septicaemia may need antibiotic regimens that provide more reliable cover for multiply resistant pathogens and examples of suitable choices are given in the list below in brackets. When septicaemia follows gastrointestinal or genital tract surgery Escherichia coli or other Gram-negative bacteria anaerobic bacteria . Bacteroides streptococci or enterococci are likely pathogens and the following combinations are effective cefuroxime plus metronidazole or gentamicin plus benzylpenicillin plus metronidazole meropenem plus vancomycin . Septicaemia related to urinary tract infection usually involves Escherichia