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Antibiotics and Outpatient Infections

Antibiotic Therapy

Factors in Choosing an Antibiotic

Clinical syndrome

Host characteristics

Focused history

Antibiotic characteristics

Assessment of Clinical Syndromes

Identify predominant symptoms and signs

Determine the site of infection

Identify disease process

Determine likely causative organisms

Identify likely susceptibility pattern

Host Characteristics

Age

Underlying conditions

Medical devices

Nutritional status

Travel

Exposures

Immunizations

Drug abuse

Sexual activity

Antimicrobial Selection Factors

Spectrum of activity

Absorption

Distribution

Metabolism

Excretion

Adverse Effects

Safety

Routes of administration

Drug-drug interactions

Cost

Palatability

Effect on Resident Flora

Selective Pressure on environment

General Principles of Antibiotic Therapy

May initiate with broad spectrum awaiting culture results

Obtain pertinent cultures to narrow therapy

Use narrowest spectrum as possible

Penicillins

Penicillin - otitis media, pharyngitis, sinusitis Adverse Effects

Allergic reactions

Hemolytic anemia

Interstitial nephritis

Seizures and hyperkalemia in patients with underlying renal disease

Penicillinase-Resistant Penicillins

Adverse Effects of Penicillinase Resistant Penicillins

Neutropenia - dose and duration related

Cholestasis and cholestatic jaundice

Interstitial nephritis - most common with methicillin

Poor palatability of oral preparations (dicloxacillin and cloxacillin)

Aminopenicillins