RT Book, Section
A1 Gulani, Perminder
A1 Chen, Julie
A1 Keene, Adam
A2 Oropello, John M.
A2 Pastores, Stephen M.
A2 Kvetan, Vladimir
SR Print(0)
ID 1136415712
T1 Antimicrobials in the ICU
T2 Critical Care
YR 1
FD 1
PB McGraw-Hill Education
PP New York, NY
SN 9780071820813
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1136415712
RD 2024/04/19
AB KEY  POINTSBecause  therapeutic  delay  has  been  clearly  shown  to  increase  mortality,  prompt  empiric  broad-spectrum  antimicrobial  therapy  is  crucial  in  patients  with  shock  and  new  organ  dysfunction  thought  secondary  to  infection.Overuse  of  antimicrobials  in  the  ICU  is  common  and  is  associated  with  multiple  adverse  drug  reactions,  superinfections  and  the  development  of  antimicrobial  resistance;  antimicrobial  therapy  should  be  tailored  as  soon  as  possible  and  courses  of  therapy  should  not  be  prolonged  unnecessarily.Beta-lactams  are  the  most  important  antibacterial  agents  used  in  the  ICU;  allergic  reactions  are  the  most  common  adverse  effects  but  are  frequently  misreported  so  the  risks  of  such  reactions  must  always  be  weighed  against  the  importance  of  these  agents  for  severe  bacterial  infections.The  aminoglycosides  are  potent  agents  against  gram-negative  bacteria  but  their  utility  is  limited  by  frequent  misdosing  due  to  concerns  of  nephrotoxicity;  extended  dosing  intervals  can  be  helpful  in  maximizing  efficacy  and  minimizing  toxicity.The  fluoroquinolones  have  activity  against  a  variety  of  bacterial  infections  in  the  ICU;  they  are  generally  well  tolerated  but  are  considered  second-line  agents  for  a  number  of  severe  sepsis  syndromes.Vancomycin,  linezolid,  and  daptomycin  are  important  agents  for  resistant  gram-positive  infections  in  the  ICU.  Their  utility  varies  by  the  site  of  primary  infection.Azithromycin  and  doxycycline  are  particularly  useful  for  atypical  bacterial  infections  in  the  ICU  and  are  generally  well  tolerated.  Metronidazole  and  clindamycin  are  useful  primarily  for  coverage  of  anaerobic  infections  in  the  ICU.Tigecycline  and  polymyxin  B/colistin  are  used  mainly  for  resistant  gram-negative  infections  in  the  ICU;  use  of  the  former  is  limited  by  lack  of  potency  and  the  latter  is  limited  by  high  potential  for  nephrotoxicity.The  three  classes  of  antifungals  used  in  the  ICU  are  the  polyenes,  the  azoles,  and  the  echinocandins.  Polyenes  are  broad  spectrum  but  nephrotoxic;  azoles  have  variable  coverage  but  resistance  can  be  a  problem;  echinocandins  are  excellent  anticandidal  agents  and  are  generally  well  tolerated.The  nucleoside  analogues  are  the  primary  agents  used  to  treat  herpes  viruses  in  the  ICU;  their  efficacy  is  variable  and  they  may  cause  hematologic  and  renal  toxicity.The  neuraminidase  inhibitors  are  important  agents  that  may  improve  the  outcome  of  influenza  virus  infections  in  the  ICU.