ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1992.tb04497.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Infection is responsible for a large percentage of morbidity and mortality in intensive care unit (ICU) patients. Conventional infection‐control measures are directed at decreasing infection by exogenous sources and have had variable success in significantly reducing nosocomial infection rates. Selective gastrointestinal decontamination with topical nonabsorbable antibiotics attempts to reduce infection by eliminating intestinal mucosal colonization by pathogenic microorganisms. These antibiotics are selectively bactericidal against gram‐negative organisms and yeasts, thereby leaving the normal flora (mainly anaerobes) unharmed. In the majority of clinical trials, selective decontamination effectively reduced colonization and infection among ICU patients, with the most significant reductions observed in gram‐negative respiratory infections. Resistance to the antimicrobials was not documented in the majority of trials; however, follow‐up periods were minimal and may not have been adequate to detect selection of resistant strains. Reductions in infection do not alter mortality; however, patients without significant underlying disease appear to be the subgroup that will most likely

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1992.tb04498.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

The primary focus of the pharmaceutical industry in past years has been on developing more potent antibiotics rather than on establishing optimum therapy with currently available agents. Concepts that can be used to tailor patient‐ and pathogen‐specific antimicrobial regimens include concentration‐dependent killing, concentration‐independent killing, and postantibiotic effect. It is possible to administer single daily doses (SDD) of aminoglycosides; however, a fixed SDD regimen cannot meet the goals for therapy in all patients. Instead, it is necessary to consider both pharmacodynamic concepts and pharmacokinetic principles. Even with tailored, patient‐specific regimens, however, limitations exist with antibiotic therapy alone. Immunotherapy, used as an adjunct to antimicrobial therapy, may play a role in improving patient

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1992.tb04499.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Over the past decade, the quinolone antimicrobial class has enjoyed a renaissance with the emergence of the fluoroquinolone subclass. Norfloxacin, ciprofloxacin, ofloxacin, enoxacin, and lomefloxacin have the advantages of broad antimicrobial activity profiles including gram‐positive and ‐negative aerobes, favorable pharmacokinetic profiles including substantial oral bioavailability and extensive tissue distribution, and in general, favorable safety profiles. As clinical experience accumulates, our understanding of their optimum roles will become more refined. In six instances, these agents may be preferred over currently available agents: complicated urinary tract infections, empiric therapy of suspected bacterial gastroenteritis, eradication of theSalmonellacarrier state, respiratory exacerbations due toPseudomonas aeruginosain patients with cystic fibrosis, invasive external otitis, and chronic gram‐negative bacillary osteomyelitis. The efficacy and convenience of these agents for the treatment of a broad range of infections have already resulted in their extensive use. Such use carries the risk of selection pressure for the development of resistance and the adverse consequences of increased cost over less expensive, equally effective alternatives. The use of the fluoroquinolones should focus on infections where there is demonstrated benefit of these agents over conventional agents or infections for which there are few or no alterna

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1992.tb04500.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

An important obstacle to the long‐term efficacy of an antimicrobial agent is the appearance and spread of resistance to the agent. The fact that many antimicrobials are produced by microorganisms in nature may provide long‐term selective pressure for the emergence of resistance in antibiotic‐producing as well as ‐nonproducing organisms. Indeed, the rapidity with which many resistances have appeared after the introduction of a new antibiotic suggests that these resistance genes were already present somewhere in nature prior to clinical use. In the hospital setting, the most recent worrisome resistance traits to emerge include plasmid‐mediated resistance to imipenem and to third‐generation cephalosporins among nosocomial gram‐negative bacteria, and the acquisition of resistance to vancomycin by enterococci. Methicillin‐resistant staphylococci continue to be a problem and are increasingly resistant to numerous other agents such as rifampin and the newer fluoroquinolones. The most important resistances seen in community‐acquired organisms include β‐lactam resistance in pneumococci and combined ampicillin and chloramphenicol resistance inHaemophilus influenzae. Shigellae resistant to essentially all commonly used oral agents are also a problem, particularly in developing countries. No end is in sight to the problem of antimicrobial resistance, and thus new strategies to prevent infections and control resistant organisms cont

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1992.tb04501.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

Dramatic changes have been made in the recommended schedule for immunizations, and for a variety of reasons: greater understanding of risks associated with whole‐cell pertussis vaccine; introduction of more immunogenic vaccines to prevent invasive disease caused byHaemophilus influenzaetype B; a national epidemic of measles that affected many vaccinated individuals; and the failure of targeted use of vaccine in high‐risk patients to reduce the occurrence of hepatitis B. Additional changes in recommended regimens can be anticipated as new products are introduced. However, for vaccines to have their greatest impact, improved adherence to recommended immunization practices is necess

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1992.tb04502.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1992.tb04503.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY